Avisons Solicitors in Leeds
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0113 831 5566

Personal Injury Claim Form

Thank you

We have received your enquiry and will respond to you within as soon as we have finished processing your claim. For urgent enquiries please call us on 0113 831 5566.

Title *
Please select your Title
First name *
Please provide your first name
Last name *
Please provide your last name
Date of Birth *
Please provide your date of birth (dd/mm/yyyy)
Email *
Please provide your email address
Contact No. *
Please provide a Contact Number
Preferred time of contact *
Please let us know the best time for us to contact you
Preferred method of contact *
Please let us know your preferred method of contact
Address (Line 1) *
Please provide your address
Address (Line 2)
Town / City *
Please enter your city
Postcode *
Please provide your postcode
Date of “accident/injury *
Please let us know on what date the accident happened
Description of accident/injury *
Please describe the accident in as much detail as possible


I declare that by submitting the form the information attached is correct.

What our customers say

Amazing service. From start to finish the team helped me get the result i deserved. I would highly recommend their services.

- Tim Mills

To find out more information speak to one of our specialists, please get in touch

Make an enquiry
0113 831 5566