Personal injury claim form template
This five-step personal injury claim form asks the accident type, when it happened, who was at fault and whether a solicitor is involved, then the contact details. You can clone this template into your Growform account and adapt it.
What the form asks, step by step
The questions cover the circumstances of the accident and leave the injury itself for a later conversation. Every answer is chosen from a short set of buttons.
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Step 1: “What type of accident was it?”
Road, workplace and public accidents are usually handled by different specialists.
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Step 2: “When did the accident happen?”
The date band shows your team how recently the accident took place.
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Step 3: “Who was at fault?”
The person’s own view of fault is recorded, and your team assesses it later.
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Step 4: “Do you already have a solicitor for this claim?”
Anyone already represented can be answered differently from a new inquiry.
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Step 5: “How shall we contact you about your claim?”
Name, email and phone come last.
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After submitting
The last screen tells the person to expect a call from a claims advisor, and you can state your opening hours.
Who it’s for
Personal injury solicitors, claims management companies and the agencies that supply them with inquiries can use this template on a campaign page. It is written for the UK market, so it refers to a solicitor and to road traffic accidents. Each submission gives the type of accident, a date band, the person’s view of who was at fault and whether a solicitor is already acting. The form does not assess the claim or predict a result, and it asks nothing about the injury or any treatment. If you know this kind of page as an accident claim form, the structure is the same.
The personal injury intake template is the US equivalent.
Why this structure converts
- The type of accident is a fact the person knows immediately, so the first answer takes a second.
- Every question offers three or four buttons, and nothing has to be typed until the contact step.
- “Not sure” is offered on the fault question, so people who are uncertain can still continue.
- The solicitor question is asked before contact details, so your team knows the position before calling.
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Make it yours
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Add your accident types
If you specialize in cycling or workplace claims, replace the four options on step one with the categories you accept.
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Record consent to a call
A consent checkbox on the contact step records that the person agreed to a call about their claim.
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Set expectations at the end
Use the closing screen to tell people when the call will come, so they are ready to answer.
Frequently asked questions
Which questions are on this personal injury claim form?
It asks the type of accident, when it happened, who was at fault and whether a solicitor is already involved. The contact step then asks for a name, an email address and a phone number.
Does the form say whether a claim will succeed?
No. It collects the answers and nothing more. Your solicitors review each inquiry and decide whether to take the claim forward.
Can I use this personal injury claim form template outside the UK?
Yes. Change “solicitor” to “lawyer” and edit the accident types to suit your market.
Where are new inquiries sent?
They arrive by email by default. You can also pass them to Clio, Actionstep, HubSpot or a Google Sheet.
What happens next?
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Step 1: Clone this form template
Clone this template into your Growform account (create one first if you don’t already have one). -
Step 2: Edit your form
Get creative and adjust your form's theme options, questions or layout in the Growform form builder. -
Step 3: Share or embed your form
Share a link to your form, or embed it in your existing website. Receive new submissions by email or send them to 7,000+ apps via Zapier.
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