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Type of Accident?
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Accidente automovilístico
Accidente de camión
Accidente de bicicleta o peatón
Accidente de motocicleta
Otros accidentes o lesiones de vehículos motorizados
How long ago was your accident?
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In the last 14 days
Within 1-3 Months
Within 3-6 Months
Within 6-12 Months
More than 1 year ago
More than 2 years ago
Were you at fault in the accident?
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No, no fue mi culpa
Si, fue mi culpa
Did the police arrive?
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Yes
No
I don't know
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First Name
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Last Name
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Phone
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Email
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