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Personal Injury and ICBC Injury Claims
we care. 604‑513‑2333
If you have any questions about how to complete this form, please contact us.
Contact Pat Yearwood or Chris Dyson today.
Part 1: Personal Information
Part 2: Employment Information
Employer at time of injury:
Part 3: The Injury
Part 4: Submit Form
To immediately submit your personal injury evaluation form over the Internet, simply click on the Submit button below. CAUTION: Information sent over the Internet is not secure, and we cannot guarantee the confidentiality of your answers. If you do not wish to send this form over the Internet, you may submit the information by printing out this page and faxing it to us at 604-513-0211 or mailing it to us at 9613-192nd St., Surrey, BC, V4N 4C7.
2 Locations to serve you:
2, 9613 - 192nd Street
Surrey, BC V4N 4C7
400 - 601 W. Broadway
Vancouver, BC V5Z 4C2
*An Association of Law Corporations