Free Personal Injury Questionnaire Template – Download Now
A Personal Injury Questionnaire is a valuable template for documenting injuries, medical treatment, and financial losses after an accident. This form helps lawyers, insurance companies, and injured individuals collect crucial details for a personal injury claim.

Why Use a Personal Injury Questionnaire?
This questionnaire ensures that all important information is recorded, including:
- Accident details – date, location, parties involved, and how it happened.
- Injury description – symptoms, severity, and long-term effects.
- Medical treatment – doctors seen, treatments received, and medical expenses.
- Work impact – lost wages and work time off due to injuries.
- Insurance and legal information – witness details and policy coverage.
Who Can Use This Personal Injury Questionnaire Form?
- Injured individuals preparing to file a personal injury claim.
- Lawyers gathering evidence for a case.
- Insurance adjusters assessing claims.
Template Categories
California
General
How to Use This Template
- Download the free template by typing in your email address in this page.
- Get the template directly in your inbox.
- Fill out all sections with accurate details about the accident and injuries.
- Share with your attorney or insurance company to support your claim.
Download Your Free Personal Injury Questionnaire Template Now
Make sure your personal injury claim is well-documented and organized. Download the free Personal Injury Questionnaire template now to simplify the process!
Related Templates
Sample IME/QME Report Template
Sample IME/QME Report TemplateAn Independent Medical Examination (IME) report or a Qualified Medical Evaluation (QME) is a vital document used to provide an unbiased medical opinion in legal, insurance, or worker's compensation cases. These reports are diligently...
Free DWC Form PR-4: Primary Treating Physician’s P&S Report Template
Free DWC Form PR-4: Primary Treating Physician’s P&S Report TemplateThe DWC form PR-4 or the Primary Treating Physician’s Permanent and Stationary Report (P&S Report) is an important document in California workers' compensation cases, submitted when an...
Request for Factual Correction of an Unrepresented Panel QME Report (QME Form 37)
Request for Factual Correction of an Unrepresented Panel QME Report (Form 37) The Request for Factual Correction of an Unrepresented Panel QME Report (QME Form 37) is an essential document in California workers' compensation cases. It allows an unrepresented injured...
Free DWC Form RFA to Request Authorization for Medical Treatment
Free DWC Form RFA to Request Authorization for Medical TreatmentThe DWC Form RFA or the Request Authorization for Medical Treatment Form is used in California workers' compensation cases to request prior approval from an insurance company or claims administrator...
QME Form 104 – Reappointment Application as a Qualified Medical Evaluator
QME Form 104 – Reappointment Application as a Qualified Medical EvaluatorThe Reappointment Application as Qualified QME (QME Form 104) is a much-required document for physicians in California seeking to renew their position as a Qualified Medical Evaluator (QME). This...
QME Replacement Panel Request Form-Download for Free!
QME Replacement Panel Request Form-Download for Free!The Replacement Panel Request Form is a significant document in California’s workers' compensation system. It allows parties involved in a claim to request a new panel of Qualified Medical Examiners (QMEs) when the...
Download QME Form 105 for Free – Complete Your QME Panel Request
Download QME Form 105 for Free – Complete Your QME Panel RequestThe Request for Qualified Medical Evaluator (QME) Panel Form 105 is a crucial document used in California workers' compensation cases to request a panel of three Qualified Medical Evaluators (QMEs). This...
QME Notice of Unavailability (Form 109) – Free Template Download
QME Notice of Unavailability (Form 109) – Free Template DownloadThe QME Notice of Unavailability (Form 109) is an essential form used in California workers' compensation cases to notify the Division of Workers' Compensation (DWC) Medical Unit when a Qualified Medical...
Download Free QME Form 121 – Protection of Mental Health Record
Download Free QME Form 121 – Protection of Mental Health RecordThe QME Form 121 is an important document used in California workers’ compensation cases to ensure the confidentiality of an injured worker’s mental health records. A Qualified Medical Evaluator (QME) must...
Free QME Form 120 Template – Download Now!
Free QME Form 120 Template – Download Now!The Voluntary Directive for Alternate Service of Medical-Legal Evaluation Report on Disputed Injury to Psyche (Form 120) is used in California workers' compensation cases when an injured worker wants their psychological injury...