OBM - Claim Assessment

1
When did the accident happen?* This field is required.
2024
2024
2023
2022
2021 or Before
2
Have you appointed a solicitor for this claim?* This field is required.
YESNO
3
What type of claim do you have?* This field is required.
Medical Negligence
Medical Negligence
Workplace Accident
Car Accident
Slip, Trip or Fall
Other
4
Please Tell Us About The Incident* This field is required.Please tell us what went wrong and how you have been impacted
Describe how the accident happened
5
What's your name?* This field is required.
6
What's the best number to reach you on?* This field is required.
7
Finally, what's your email?* This field is required.
example@example.com
8
I agree to the O’Brien & Company Solicitors Privacy Policy* This field is required.By ticking this checkbox, you agree to the O’Brien & Company Solicitors Privacy Policy
I agree
Other
Should be Empty: