http://www.PremierHealthRehab.com Dr. Guevara 678-223-3900 http://www.Facebook.com/AtlantaChiropractor

1. Fill out this report as completely as possible: Location of collision:
Atlanta 1. Police called? Yes No
Direction of travel:
Car Accident Checklist 2. Other vehicle information: Your vehicle:
Other vehicle:
Driver:
Keep a pen and a copy of this Accident Checklist in your Name:
glovebox. After you obtain the info about your accident, Injuries:
Address:
call Atlanta's Car Accident Doctor at 678-223-3900 for a Your own:
Phone:
complete check up and to help you recover from injuries Your passengers:
Driver’s License:
fast! Other driver:
Relationship to registered owner:
Their passengers:
If you’re involved in an auto accident: Registration: Pedestrians:
Name of registered owner:
1. Stay as calm as possible. Address: Area of Damage:
2. Check for injuries. Safety is more important than License Plate: Expiration Date:
Your vehicle:
vehicle damage. Call an ambulance if needed. Other vehicle:
Vehicle:
3. Turn on your hazard lights. Use cones, warning triangles VIN: Other property:
or flares for safety. Make:
4. Call the police, even for minor accidents. Model: Diagram of Accident Scene:
Year: Color: Using these symbols sketch a diagram showing positions of all
5. Make immediate notes about the accident including the
Insurance Company: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ vehicles, your position, stop lights, stop signs and
specific damages to all vehicles involved.
Policy Number: ______________________
pedestrians.
6. Be polite and state only the facts. Don’t tell the police or other
Phone: _____________Exp Date:________
drivers that the accident was another driver’s fault or was
your fault. Let the police sort out all the facts to establish what
happened. Other passengers:
7. If a camera is available and the scene is safe, take photographs A. Name:___________________________________
Age:__________ Male____ Female ____
8. Notify your insurance agent about your accident immediately
Address:_________________________________
Phone: __________________________________
B. Name
Age:__________ Male____ Female ____
Address:_________________________________
Phone: __________________________________
3. Accident Information
Police report taken? Yes ___ No ___
Report Number ______________________________
Officer Name ________________________________
Badge Number ______________________________
Call 678-223-3900
For Immediate Medical Treatment for Your Accident Injuries
www.PremierHealthRehab.com