About this template
When an auto accident occurs, collecting accurate, detailed information quickly is critical for insurance agents, claims adjusters, and policyholders. This Car Insurance Accident Information Google Form template streamlines the reporting process by capturing all essential data points in one organized submission. Instead of chasing missing details over the phone, policyholders can complete a comprehensive questionnaire detailing what happened, who was involved, and the extent of any injuries.
The template covers everything from basic contact details and vehicle descriptions to specific insurance policy numbers, claim references, attorney information, and medical treatment status. By structuring these questions logically, insurance professionals ensure they receive complete information right from the start, minimizing processing delays and reducing back-and-forth communication.
Built on Google Forms through Doc2Form, this template allows your team to receive instant email notifications for every new submission, securely store data in Google Drive, or connect responses to your agency's CRM and claims management systems. It provides a reliable, professional, and accessible way to handle sensitive accident disclosures while keeping your workflow running smoothly.
Key features
- Collect comprehensive crash and vehicle details in a single step.
- Capture policy numbers, adjuster contacts, and claim references accurately.
- Document injury levels, medical care status, and prior medical history.
- Built-in mobile compatibility for policyholders reporting on the go.
- Instant data organization via Google Sheets and Google Drive integration.
Use cases
- Insurance agencies logging new client auto accident claims.
- Independent adjusters gathering preliminary incident reports.
- Legal teams collecting initial client intake data following a crash.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Birth Date (Date)Enter your date of birth.
- Phone Number (Short answer)Enter your primary contact phone number.
- Address (Paragraph)Enter your current residential address.
- Accident Date (Date)Select the date the accident took place.
- Accident State (Short answer)Enter the US state where the accident occurred.
- Cars Involved Count (Dropdown)How many vehicles were involved in the collision?
- At-Fault Party (Multiple choice)To the best of your knowledge, who was determined to be at fault?
- Accident Description (Paragraph)Describe how the accident happened in your own words.
- Insured Full Name (Short answer)Name of the primary policyholder.
- Insurance Company (Short answer)Name of your insurance provider.
- Policy Number (Short answer)Enter your active insurance policy number.
- Claim Number (Short answer)If already assigned, enter your claim number.
- Adjuster Full Name (Short answer)Name of assigned insurance claims adjuster, if known.
- Adjuster Phone Number (Short answer)Phone number for your claims adjuster.
- Current Symptoms (Paragraph)Describe any physical discomfort or symptoms you are experiencing.
- Pain Level (Linear scale)Rate your current pain level on a scale from 1 (minimal) to 10 (severe).
- Physician Care Status (Multiple choice)Have you seen a doctor or visited a hospital for your injuries?
- Medication Use Status (Multiple choice)Are you currently taking any prescription medications related to the accident?
- Medication List (Paragraph)If yes, please list the medications you are taking.
- Prior Injuries Status (Multiple choice)Did you have any prior injuries to the affected body parts before this accident?
- Prior Injuries Details (Paragraph)If yes, please provide details regarding any prior injuries.
FAQ
How do I share this accident information form with my policyholders?
You can easily share the form via a direct link, email it as an invitation, or embed it directly on your agency website so clients can access it immediately after an incident.
Can I customize the questions to fit our specific insurance claims process?
Yes! Once you generate the form using Doc2Form, you have full control over Google Forms to add, remove, or modify any questions to match your exact requirements.
Where are the accident report submissions stored?
All responses are automatically saved in a secure Google Sheet connected to your form, allowing your team to review, sort, and export data instantly.
Is this template mobile-friendly for clients filling it out from a smartphone?
Absolutely. Google Forms automatically optimizes layouts for mobile devices, making it easy for policyholders to submit details right from the scene of an accident.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.