Please fill in the fields below Was it an accident? -- Choose --YesNo You have had an accident Date of your accident Your accident coverage —Veuillez choisir une option—basesemi-privateprivate Please specify the date and place of each additional examination (X-ray, MRI, etc...) Please send us all the documents related to your various exams (1Mb max per attachment) Document 01 Document 02 Document 03 Document 04 Document 05 You have not had an accident Date of onset of your symptoms Your accident coverage —Veuillez choisir une option—basesemi-privateprivate please specify the date and place of each exam Please send us all the documents related to your various exams (1Mb max per attachment) Document 01 Document 02 Document 03 Document 04 Document 05