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Cruise Ship Liability Form

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Cruise Ship/Maritime Liability Case Form

NOTE:  An Asterisk (*) Indicates REQUIRED Information.

*Full Name:

  

Home Address:

City:

State:

Zip:

Phone Number:

  

*E-mail Address:
 

What Cruise line and ship were you traveling on when you were injured?


 

When did you sustain your injury?


 

Describe your injury and how it happened?


 

What did the staff of the boat do to help?


 

Was further medical attention required, if so, what type of medical care and treatment did you receive?


 
   

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