Personal Injury Intake Form Template
A personal injury intake form for law firms and legal professionals to collect accident details, injuries, treatment, insurance information, witness details, and photos from potential clients.
When to use it
- When a potential client first contacts your firm
- After a car, workplace, or premises accident
- To gather details before an initial consultation
- To collect accident photos and witness information
What it asks
- What is your full name?
- What is your email address?
- What is your phone number?
- When did the accident happen?
- Where did the accident happen?
- How did the accident happen?
- What injuries did you suffer?
- What medical treatment have you received?
- Is there insurance related to the accident?
- What is the insurance company’s name?
- What is the insurance claim number, if available?
- Were there any witnesses?
- Upload any photos related to the accident or your injuries.
Why it should be encrypted
Accident accounts, injury details, treatment history, insurance claims, and photos can reveal private personal and medical information. Only the intended legal team should be able to read these answers.
Tips
- Tell people which dates, locations, and details are most helpful.
- Explain what kinds of photos to upload and whether they should avoid including unrelated people.
- Ask respondents to enter a claim number only if they have one.