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Home
About Us
Services
Medico Legal Psychological Assessments
Therapy for Adults
Training
All Training
Training Calendar
DDP Training
Theraplay Training
Circle of Security
Assessment Skills for Fostering and Adoption
Build Bridges
Contact Us
Personal Injury Law ROI
Claimant’s Details
Forename
(Required)
Surname
(Required)
Date Of Birth
(Required)
Address
(Required)
Street Address
Address Line 2
City
County
Postcode/Eircode
Next of Kin & Relationship To Claimant (If A Minor)
We require your clients email and mobile number for appointment reminders and arranging video consultation. We will also use this to contact your client in the event they experience any technical difficulties.
Email
(Required)
Contact Number. Please include area code
(Required)
Solicitor’s Details
Practice Name
(Required)
Forename
(Required)
Surname
(Required)
Email
(Required)
Contact Number. Please include area code
(Required)
Solicitor’s Name (If Different From Above)
Forename
Surname
Reference Number For Your Client
Details Of The Index Event
Nature Of Injury? It is important you inform us if there was loss of life or catastrophic injury suffered
(Required)
Date Of Injury
(Required)
DD slash MM slash YYYY
Please Indicate If You Intend To Share Relevant Notes/Records Or Reports
Any Other Relevant Information
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