Confirm the follow information with the client via call.

#call-out
Date of Loss=
Location = 
Facts of Loss =
Injuries/Pain levels = 
Treatment = 
Emergency Room/Ambulance = 
Marital Status = 
Animal Report = 
Pictures of your injuries=
Pictures of the scene/ dog = 
Health Ins (Medical/ Medicare) =
SSN (social security number) =
Driver License/ ID= 
Witnesses = 
Loss of Earnings = 
Contact Info = 
Previous Injuries/ Accidents/ Attorneys/ Worker’s compensation=
Things cannot longer do at all or can, but with pain =



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