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Intake Form - Auto Accident

This intake form is to be used by an attorney or staff member to obtain information from a client regarding an auto accident. In addition to the pertinent facts about the accident itself, this form includes questions regarding client employment, litigation and medical history.

This packet includes:
(1) Auto Accident Client Intake Form Information
(2) Auto Accident Client Intake Form

State Law Compliance: Designed for use in all states.

Among others, this form includes the following provisions:
  • Referred by
  • Client Information
  • Employment
  • Health Insurance
  • Prior Claims
  • Prior Medical Treatment/Care
  • Accident Information
  • Client Vehicle
  • Adverse Information
  • Medical Treatment
  • Witnesses

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    Product Specifications

    Product Intake Form - Auto Accident
    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
    Sample Available (requires Flash plug-in)
    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
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    * According to the 2007 Altman Weil Survey of Law Firm Economics, the average attorney rate is $252.50 per hour.