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What type of injuries do you have?
Automobile Accident Dog Bite Wrongful Death
Construction Site
 Defective Product
 Other
What is the extent of your injuries?
Have you seen a doctor?
Yes
 No
What are your medical bills?
Have you filed any claims?
Yes
 No
Do you have insurance that covers you for this type of incident?
Yes
 No Not Sure
Do other involved parties have insurance that covers this type of incident?
Yes
 No Not Sure
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