This Intake Form for an Auto Accident includes the following:
- Client Name and Referral: Sets out the name of the client and how he or she was referred (television commercial, newspaper, yellow pages);
- Client Information: Client’s full name along with any aliases, address, phone number, date of birth, detailed physical information, criminal record, nearest relative to contact information and if client has taken bankruptcy;
- Employment: Client’s employment information at the time of the accident and if employer was notified;
- Health Insurance/Prior Claims: Client’s health insurance information and if any prior insurance claims or medical treatments have occurred;
- Accident Information: Detailed information regarding the accident including the date, time and location, road and weather conditions, description of what happened, vehicle description and if estimates of damages have been received;
- Adverse Information: Information regarding the other driver including name, contact and insurance company information;
- Medical Treatment: Information regarding medical treatment sought after the accident and any follow-up care or prescriptions given;
- Witnesses/Other Information: The name and phone numbers of any witnesses to the accident and other information which may be important for client’s case.
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This attorney-prepared packet contains:
- General Information
- Auto Accident Client Intake Form
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Product Specifications
| Product | Intake Form - Auto Accident |
| Country | United States |
| State | All |
| Pages | 5 |
| Dimensions | Designed for Letter Size (8.5" x 11") |
| Printer compatibility | Designed to print on all ink-jet and laser printers |
| Editable | Yes (.doc, .wpd and .rtf) |
| Format |
Microsoft Word Adobe PDF WordPerfect Rich Text Format |
| Platform | Windows Compatible Mac Compatible Linux Compatible |
| Availability | In Stock. Instant Download |
| Usage | Unlimited number of prints |
| Category | Attorney - Client Correspondence |
| Product number | #28061 |
| Download time | Less than 1 minute (approx.) |
| Document Access | Via secret online address Email with download links Email with attachment upon request |
| Refund Policy | 60 days, no-questions asked, 100% money back guarantee |
| Support | Customer support 1-800-959-5899 Online support Additional Help |
Our Promise to You:
We provide accurate, legal and secure forms. All of our forms are prepared by lawyers, can be downloaded and accessed immediately, and are backed by a 100% money back guarantee – if you are dissatisfied, in any way, you get your money back.
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