Intake Form - Auto Accident
This Auto Accident Intake Form is for use by an attorney when gathering information from a client regarding an auto accident. This form contains many questions regarding the client including full name, contact information, employment and health insurance information and any prior medical treatments. This Intake Form also includes detailed information regarding the accident itself, vehicle description and names of any witnesses.
This Intake Form for an Auto Accident includes:
- Client Name/Referral: Client's name and how referred;
- Client Information: Client’s full name along with any aliases, address, date of birth, physical information, criminal record and if client has filed for bankruptcy;
- Employment: Client’s employment information and if employer was notified about the accident;
- 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 location, road and weather conditions, detailed description and vehicle description;
- Other Driver Information: Information regarding the other driver including name and insurance company information;
- Medical Treatment: Information regarding medical treatment sought after the accident and any follow-up care necessary;
- Witnesses/Other Information: Name and phone numbers of any witnesses and other pertinent information.
Purchasing this
Auto Accident Client Intake Form will save you time and money. Our forms are
prepared by attorneys and you will feel confident you are using an up-to-date form.
- General Information
- Auto Accident Client Intake Form
State Law Compliance: This form complies with the laws of all states
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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 |
| 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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