Online Claim Form from Impact Assist

If you have been involved in an accident and would like some help from Impact Assist, then simply fill out the form below and one of our representatives will be in touch shortly to go through the details with you. Please view our privacy policy in Terms & Conditions.

Name *	Contact by *
Telephone (day)	Tel (eve)
Mobile	Email *
Address
Date of accident *
Accident Details * Please describe briefly how the accident happened, or FREEPHONE 0800 043 0907 to talk to us instead.

Impact Assist Ltd is regulated by the Ministry of Justice in respect of regulated claims management activities; it's regulation is recorded on the website www.claimsregulation.gov.uk.

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