Sher Legal Free Claim Check

Sher Legal Free Claim Check
Full Name*

First NameLast Name
Phone Number*
E-mail
example@example.com
Date of Birth

MonthDayYear
Date
Have you or another person suffered an injury or illness at work?

YesNoMaybe
Where were you normally working when the injury occurred?

NSWOther
Were you employed in any of the following Occupation?

Police OfficerCoal MinerEmergency Service PersonnelOther
Do Any of the following situation apply to you?

You were admitted to the HospitalYou were previously been admitted to the Hospital or Rehabilitation Centre for 3 days or more because of the the worse condition?My Enquiry Related to Loss of LifeNone of the above
Did you sustain any of the following injuries as a result of your work-related accident?

Injury to the Neck or BackInjury to the Hip, Knee or LegInjury to Shoulder, Elbow or WristAmputation of the Body PartHead Injury involving a Skull FractureLung or Stomach Condition from exposure to harmful SubstancePsychological IllnessNone of the Mentioned Above
Did you require surgery?

YesNoMaybe
Have You been referred to see the Specialist?

YesNoMaybe
How did you hear about us?*
Any other detail you want to discuss with us.
Should be Empty: