Get in touch with us about reserach. Contact us about research Information About You We need your basic contact information in order to correctly identify you and begin your dispute resolution process. First Name(s) * test Last Name * test Phone Number * (Mobile preferred) test Personal Email * test Address Line 1 * Street Address test Address Line 2 Suburb / Additional Address Details test City / Town * test Postcode test Information About Your ACC Dispute We require preliminary information about your interactions with ACC in order to begin your dispute resolution process. ACC Claim Number (if you know your claim number) test Date of decisions made by ACC (if you know the date of decisions) test Tell us in a few sentences about the issue with ACC (for example: cover for your injury, entitlement to weekly compensation for loss of earnings, or entitlement to treatment) test Demographic Information We also collect optional demographic information so we can understand barriers to accessing our services. Ethnicity Please select...EuropeanMāoriPacific PeoplesAsianMiddle Eastern/Latin American/AfricanOther Ethnicity test (Select the ethnicity you identify most with) Age test Gender Please select...MaleFemaleAnother genderPrefer not to answer test Confirmation of Application * I confirm that I have provided this information in order for ACC Advocacy to contact me. I agree to the required Terms of Use Pathways to Resolution. test Fax * Unfortunately there are errors with your form - please ensure all fields are filled correctly Enquiry Successfully Sent A member of our team will be in touch with you soon.