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Dr. John Smith,

St. Jones's Hospital,

Anywhere in Ireland

Dear Doctor/Mr.

We Act for Mr./Mrs./Miss who suffered personal injuries as a result of an accident on or about the day of 1987.

We have now been consulted to pursue a Civil claim for damages on behalf of our client and to assist us in preparing our Statement of Claim we require a detailed Medial Report on the nature and extent of our client's injuries. Please note that in accordance with the agreement reached between the Law Society and the I.M.O the Report which we require should set out clearly the following information and if possible in the following chronological order:-

1. The date of birth of the Plaintiff.
2. The occupation of the Plaintiff
(setting out where necessary or desirable the nature of same).
3. A brief history of the accident.
4. Details of the injuries received.
5. The nature of the treatment received by the Plaintiff for those injuries.
6. Details of the Plaintiff's complaints at the date of the examination
for the preliminary Medico/Legal Report.
7. Details of all relevant pre-accident history.
8. An opinion as to the then condition of the Plaintiff.
9. The prognosis
(including any additional treatment recommended).

Facts having a bearing on the issue of liability or quantum between the Plaintiff and the Defendant should not be included in the Report.

If you require our client to attend you specifically for the purposes of preparing this Report please let us have an early appointment for our client to attend.

Please let us hear from you as a matter of urgency.

Yours sincerely