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Our Lawyers
What We Do
Contact Us
Panorama Legal LLP
Unit 309, 5577 153A Street
Surrey, BC, V3S 5K7
Canada
(604) 372-4550
Important! Every question with an asterisk next to it must be answered to submit the form.
Full Name
*
Date Completed
*
MM
DD
YYYY
Current Symptons
*
Please write down your current symptoms in the format below separated by a comma
Functional Limitations (bending, housekeeping, gardening, etc.)
*
Please write down your current limitations in the format below separated by a comma
Current Prescriptions
*
Please write down your symptoms in the format below separated by a comma
Injury-Related Appointments Since Last Update
*
Please write down any injury-related updates in the format below separated by a comma
New Expenses (e-mail additional list if necessary)
*
Please write down your new expenses in the format below separated by a comma
Return to Work
*
Please select the option that describes your return to work best
Working as I did before my injuries
Working, but not like before my injuries
No change in work since my injuries
Additional comments
Symptoms preventing you from working properly (if any)
Changes needed for you to be able to work normally (if any)
Thank you!