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A full-service law firm, Nixon Wenger LLP is committed to our clients.
We pride ourselves on providing excellent legal advice.

Personal Injury Litigation Intake Questions

Name(Required)

Prefix First Last

Maiden Name

Preferred Name

Date of Birth(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Phone(Required)

SIN

Drivers License

MSP

Are you an existing client of Nixon Wenger?(Required)

Yes

Occupation

Employer

Annual Salary

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Canada

ACCIDENT INFORMATION

Location of Accident

(If it was a slip and fall, what is the Place AND Address of the accident)

Date

ICBC Claim #

CRT # (if any)

Police Attend?

Ambulance Attend?

Taken to hospital?

If yes, which one?

Briefly Describe Incident

Injuries Sustained from Accident?

Have your injuries caused you to miss any work or school?

Is ICBC paying for IRB (Income Replacement Benefit). If no, please explain

Is ICBC paying for your treatment?

If no, please explain

Attach all photos

Drop files here or

Max. file size: 10 MB.

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Contact Us

#301-2706 30th Avenue
Vernon, B.C. Canada
V1T 2B6

Wheelchair Accessible

Hours: 8:00 am to 4:30 pm, Monday to Friday

Telephone: 250-542-5353
Toll-Free: 1-800-243-5353
Fax: 250-542-7273

Get Directions

#301-2706 30th Avenue
Vernon, B.C. Canada V1T 2B6

Get Directions

Hours: 8:00 am to 4:30 pm
Monday to Friday

Wheelchair Accessible

Telephone: 250-542-5353
Toll-Free: 1-800-243-5353
Fax: 250-542-7273