Swift Medical Services : Solicitors/Insurers Instruction Form

Solicitors / Insurers Instruction Form

Please send a copy of your instruction letter by e-mail attachment to instructions@swiftmedical.co.uk or scroll down completing the following "Details" sections.

If you have not submitted the full original letter please provide the following contact information.

If you submit the Swift Reference Number for your firm then you can omit your own company details.

You will not be charged for submitting this form.

Your Swift Reference No.

Title

Your First Name

Your Last Name

Firm/Organisation

Address

Town

County

Postcode

Work Phone

FAX

E-mail

Select the type of instruction that applies:

For a new instruction please complete the following:

Your Firm's Case reference No.

If you have a preferred expert please state their name here

Claimant's Title

Claimant's First Name

Claimant's Last Name

Age

Address

Town

County

Claimant's Postcode

Home Phone

Work Phone

Enter the date of accident
dd/mm/yyyy

Instruction details