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Please select below if an Auto Accident caused your injuries
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Auto Accident
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Please Select which of the following best describes your accident.
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I was a pedestrian crossing the street
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I was driving my car
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I was riding my motorcycle
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I was riding my bike
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What was the date of your accident
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Where were you struck
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Where was your vehicle struck
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Where was your motorcycle struck
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Where was your bicycle struck
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Please type in the make and model of the vehicle that struck you
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Please enter the MPH that the vehicle that struck you was traveling.
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Did you hit your head during the accident?
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Did you lose consciousness during the accident?
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Please select if you did not go to the hospital.
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Please select if you were taken to the hospital via ambulance.
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Which hospital were you taken to?
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Please select if were not taken to the hospital initially but later went to the hospital on my own.
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Which hospital did you go to?
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Please select any diagnoses or issues that you have from the accident.
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Please select any ongoing issues that you are experiencing since the accident.
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