Instructing Party Details

Name

Address

Fee Earner's Email
Instructing Date

Reference

Telephone
Facsimile

E-mail

Other point of contact

Claimant Details

Name

Address
Date of Birth

Accident date

Home Telephone
Work Telephone

Mobile Number

Litigation Friend Details

Name

Address
Postcode

Date of Birth

Home Telephone

Work Telephone
Mobile Number

E-mail

Association with client?

DVD Information

How many edited DVD's do you require?

How long approximately does the edited DVD need to be?

Would you like the DVD to be captioned and to what extent?

Would you like the DVD to be chaptered?
Do you require an unedited version of the DVD? If yes, how many copies?

What is the purpose of the DVD? For insurers, court etc.

Will the DVD be used on a PC, DVD player or both?

Do you require an audio version and/or a non-audio version?

Additional Information

Name/nature of disability / condition or injury

Does it have any effect on brain function?

List daily tasks which are affected e.g. getting dressed, bathing, shopping etc.

What level of care is required as a result of the injury / condition and how is it provided?

Has the claimant had to move home as a result of the injury/condition? Have any adaptations had to be made to their accommodation?

Is access to any part of the accommodation restricted or needed to be changed?

How is access beyond the home environment facilitated e.g. mobility scooter etc.?

Do any other relevant activities take place outside the home?

Does the claimant receive any relevant therapies e.g. physio, occupational?

What medication is administered and how often and by whom?

Is there a deadline by which you need the DVD?

Is there a point of contact other than the claimant i.e. family member / carer?

Are there any special arrangements regarding access to the claimant’s property e.g. keysafe?

Photofile will compile a list of activities / locations to be filmed based on your requirements for your approval before issuing instructions to the videographer.

Would you like to receive information in relation to any of the below products, in relation to this claim?