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Today's Date:
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Date of the accident:
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Was the accident out of state?
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If so, where?
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How did the accident happen?
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Were you the driver or passenger?
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Were you wearing a seatbelt?
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Did the airbags deploy?
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Were you aware of the impact or collision?
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Were you looking straight ahead, or was your head turned?
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Did you go to the ER?
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If so, when?
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X-rays? Area of X-rays? Treatment? Recommendations?
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Any other doctors or treatment involved after the accident?
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