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Describe your injuries.

How you were injured?

If you were injured in a motorized vehicle accident (any kind of motorized vehicle), how much damage occurred to the involved vehicles?

Were you hospitalized because of your injuries?

Yes
No

-- If yes, for how long?

Has you doctor told you that you will be permanently disabled in any way?

Yes
No

Has any insurance paid your medical bills so far?

Yes
No

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