Cruise Ship Injury Questionnaire
Please fill out this form as best you can.
Injured person's first name
Injured person's last name
Injured person's D/O/B
Primary phone number
Primary email address
Which cruise line did you sail on?
What was the name of the cruise ship?
What date did the injury occur?
Location of the incident
Was the injury/incident reported to ship personnel (security, guest services, etc.)?
Select an option
Yes
No
Please describe how you were injured
Please describe the nature of your injuries
Please attach any photos/videos of any aspect of your injuries, or conditions aboard the ship, if available
Select a File
If The Edmonson Law Firm cannot help, do we have your permission to refer your case to suitable partner within our referral network?
Select an option
Yes
No
Your signature is to verify that the above information is accurate to the best of your knowledge.
Your Signature
*
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Please acknowledge: The use of the internet or this form for communication with us or any individual member of the firm does not establish an attorney-client relationship. Confidential / time-sensitive information should not be sent via this form.
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