Barker Son and Isherwood Solicitors

Personal Injury Compensation Enquiry Form

Richard Gregory Partner

Personal Injury Compensation Enquiry Form

Please fill in the boxes below and press the 'Submit' button. We will respond as quickly as possible.

About the Injured Person

Name -

Address 1 -

Address 2 -

Town -

County -

Post Code -

Telephone Number -

Date of Birth -

E-Mail Address -

About You (If you are not the Injured Person)

Name -

Address 1 -

Address 2 -

Town -

County -

Post Code -

Telephone Number -

E-Mail Address -

About the Accident

Date of Accident -

Type of Accident -

Please submit brief details of how the accident happened -

Please submit brief details of the injuries you have suffered -

Please submit brief details of any out of pocket expenses that you have occurred -

How would you prefer that we contact you -



You can submit the completed form by entering "submit" above. Alternatively you can print off this form and complete it by hand and either post it to Richard Gregory at 32 High Street Andover Hampshire SP10 1N T or fax it to us on 01264 356549. If you need further advice please telephone us on Freephone 0800 3765055 and ask for Richard Gregory or telephone him on 01264 353411. We will use the information contained in this completed form to make contact with you and provide a preliminary assessment of your claim within 48 hours.

Barker Son & Isherwood LLP, 32 High Street, Andover, Hampshire SP10 1NT
Telephone: 01264 353411 Fax: 01264 356549 DX: 90303 ANDOVER

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