Accident Questionnaire (ABC 55099) - Alberta Blue Cross 2026

1. Click ‘Get Form’ to open the Accident Questionnaire in the editor.
2. Begin by filling in your personal information, including your last name, first name, middle initial, group/policy number, ID number, birth date, gender, and contact details such as address and phone numbers.
3. Provide details about the accident. Start with the date of injury and location. Indicate whether you were driving at the time and describe your journey before the accident.
4. Answer questions regarding police involvement. Specify if the accident was reported to the police and provide relevant dates and details if applicable.
5. Detail any injuries sustained and provide witness information. Use additional space if necessary for a complete description of events surrounding the accident.
6. Indicate whether you are pursuing legal action and provide your lawyer's contact information if applicable. Finally, sign and date the form to confirm accuracy.

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