Thank you for contacting us. We appreciate this may be daunting, though you’ve taken the first step in seeking access to justice. To enable us to establish if and how we can help, please complete this questionnaire providing clear and accurate information.

If you aren’t sure of anything, don’t worry, just answer what you can, and we’ll guide you through the rest. When you’ve finished, press ‘Submit’, then one of our friendly team will be in touch as soon as possible. If you don’t think you can complete this questionnaire in one sitting, please click ‘Save draft’ and when you return at a later date, you can pick up where you left off.

Please note, we will need you to fill in all of the fields below. While some of the fields are marked as 'optional', the are in fact all required and we will need you to proivde as much detail as you can. You will also need your NBE number to fill in this webform. You NBE number can be found in the email that contained the link to this webform.

Your NBE number starts with 'NBE' followed by 5 numbers, e.g. 'NBE12345'. You will find this in the email that contained the link to this form.


Your details

Address
Are you contacting us on behalf of someone else?
Are you contacting us on behalf of someone else?
 
Is the person you are acting on behalf of deceased? (optional)
Is the person you are acting on behalf of deceased?
 


Please answer the questions below as best as you can on behalf of the injured or deceased person.
 

Their details

If deceased, did they have any of the following? (optional)
Please select all that apply.
 


Please answer the questions below as best as you can on behalf of the injured or deceased person.
 

Their details

Address (optional)
Have you contacted any other solicitors regarding this enquiry? (optional)
Please answer the below questions as best as you can

Have you contacted any other solicitors regarding this enquiry?
 
Have you suffered any financial loss as a result of your injury? (optional)
Have you suffered any financial loss as a result of your injury?
 
If yes, please select all that apply (optional)
Have you contacted any other solicitors regarding this enquiry? (optional)
Please answer the below questions as best as you can

Have you contacted any other solicitors regarding this enquiry?
 
Have you suffered any financial loss as a result of your injury? (optional)
Have you suffered any financial loss as a result of your injury?
 
If yes, please select all that apply (optional)
Do you have any supporting evidence you would like to share with us? (optional)

Do you have any supporting evidence you would like to share with us?
 
Do you have any supporting evidence you would like to share with us? (optional)

Do you have any supporting evidence you would like to share with us?
 
Thank you very much for filling in this form, this will be really helpful for us to understand your situation a little bit better. If you selected 'yes' to sharing supporting documentation with us, a member of the team will be in touch to securely collect that from you.
Thank you very much for filling in this form, this will be really helpful for us to understand your situation a little bit better. If you selected 'yes' to sharing supporting documentation with us, a member of the team will be in touch to securely collect that from you.