Sample of Personal Injury Report

July 18, 2002

Mr. John Doe
Attorney at Law
15555 Ventura Blvd, #100
Encino, CA 91436

RE: Steve Smith
DOI: May 17, 2001

Dear Mr. Doe,

Pursuant to your request, I am providing you a comprehensive summation regarding the injuries sustained by your client.

HISTORY:

Mr. Smith first presented himself into this office on May 18, 2001 for the purpose of examination and treatment of injuries sustained to Mr. Smith in an automobile accident on May 17, 2001 with primary complaints of neck pain, upper back pain.

Mr. Smith stated he was a passenger seated in the front seat of an 1993 Acura Integra heading northbound on Interstate 170 at approximately the Sherman Way exit. While the car was traveling approximately 55 m.p.h. The vehicle Mr. Smith was traveling in was struck from behind by a Uhaul truck that was approximately 10 feet in length. Mr. Smith indicated he was unaware of the impending collision and his hands were on his lap at the time of impact and was facing straight ahead.

Mr. Smith stated the forces of this accident were from the rear left side of the Integra. According to him, he was propelled forward and to the right side, striking the right side window. Mr. Smith was wearing a seat belt. The patient stated he felt nervous, anxiety, nauseous and weak immediately after the accident. Neck and back pain came on gradually as the day went on.