Before you fill it in
- Have the date of the accident, where it happened and how it happened ready. ACC needs a brief description of the event.
- If you already have an ACC claim number for this injury, you do not need a new form. Bring the number to your appointment and we will see you under the existing claim.
- Completing the form does not guarantee cover. Your chiropractor still needs to assess the injury at your first appointment, and cover is ACC's decision.
Not sure whether your injury qualifies? Read how ACC works, or book a first appointment and we will work it out with you.