Personal Injury Intake
State:
Multi-State
Control #:
US-PI-0003
Format:
Word;
Rich Text
Instant download
Description Personal Injury Car Accident Intake Form
This assortment of forms are to be used by the attorney to assist in the collection of information regarding new clients. Among the forms included are interview forms, employment contract, various releases, and client instructions.
Free preview Persoanl Injury Intake Form
How to fill out Intake Sheet Form Fill?
1. Personal Information:
- Full name
- Date of Birth
- Address
- Phone Number
- Email Address
2. Accident Information:
- Date and time of accident
- Location of accident
- Description of how the accident occurred
- Was a police report filed?
3. Injuries:
- List of injuries sustained in the accident
- Medical treatment received for injuries
- Doctor's name and contact information
4. Witnesses:
- Names and contact information of any witnesses to the accident
5. Insurance Information:
- Insurance company name
- Policy number
- Contact information for insurance company
6. Losses/Damages:
- Any property damage as a result of the accident
- Lost wages
7. Signature:
- Signature of the injured party acknowledging the accuracy of the information provided
It is possible to fill out a Personal Injury Intake Sheet form online. Users can find up-to-date lawyer-approved, state-specific form templates on US Legal Forms. These forms can be completed or downloaded in Word, PDF, and RTF formats. In order to access these forms, users must register and purchase a Basic or Premium subscription on a monthly or annual basis.
- Full name
- Date of Birth
- Address
- Phone Number
- Email Address
2. Accident Information:
- Date and time of accident
- Location of accident
- Description of how the accident occurred
- Was a police report filed?
3. Injuries:
- List of injuries sustained in the accident
- Medical treatment received for injuries
- Doctor's name and contact information
4. Witnesses:
- Names and contact information of any witnesses to the accident
5. Insurance Information:
- Insurance company name
- Policy number
- Contact information for insurance company
6. Losses/Damages:
- Any property damage as a result of the accident
- Lost wages
7. Signature:
- Signature of the injured party acknowledging the accuracy of the information provided
It is possible to fill out a Personal Injury Intake Sheet form online. Users can find up-to-date lawyer-approved, state-specific form templates on US Legal Forms. These forms can be completed or downloaded in Word, PDF, and RTF formats. In order to access these forms, users must register and purchase a Basic or Premium subscription on a monthly or annual basis.