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?
Area(s) to be photographed
Special instructions
Require a photographer of a specific gender?

YesNoNo Preference/Client’s Decision

Format and Quantity of Reports

Please choose from the following 2 options:

  • One hard copy of the report (further copies are available – see below)
  • One digital copy suitable for portal via email (provided quality is not compromised due to the number of images) NB Not suitable for printing
  • One high resolution disk suitable for printing

  • Two hard copies of the report (further copies available – see below)

Do you require an additional high resolution version of the report on a disk at a cost of £35.00 + VAT?

If you require additional hard copies, how many do you need?

A charge of £35.00 + VAT will be made for each additional report ordered at the time of instruction.
Copies ordered at a later date will be charged at £45.00 + VAT each.

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