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Personal Injury Intake Form

For personal injury attorneys, paralegals, and legal intake specialists

Streamline your personal injury client intake process with our comprehensive intake form template. Perfect for personal injury attorneys and legal professionals to efficiently collect essential client information, accident details, injury information, insurance details, and case specifics while ensuring thorough case preparation and maximizing settlement potential for auto accidents, slip & fall, workplace injuries, and other personal injury matters.

Personal Injury Intake Form form template preview

Key Benefits

Streamline personal injury client intake with comprehensive form template
Collect all essential accident and injury information systematically
Ensure thorough case preparation for maximum settlement potential
Reduce intake time and improve case evaluation efficiency
Professional form design builds client confidence and trust

Common Use Cases

Personal injury attorneys collecting client informationAuto accident and slip & fall case preparationWorkplace injury and medical malpractice intakeInitial client consultations and case assessmentInsurance claim documentation and settlement preparationClient onboarding for personal injury law firms

Frequently Asked Questions

What information should be collected in a personal injury intake form?
Essential information includes client details, accident information (date, time, location, type), injury details, insurance information, employment/income data, prior medical history, and supporting documentation. Our form covers all required elements for personal injury cases.
How does this form help maximize settlement potential?
The form systematically collects all information needed for case evaluation, including accident details, injury documentation, insurance coverage, and financial impact. This comprehensive data collection helps build stronger cases and negotiate better settlements.
Is this form suitable for different types of personal injury cases?
Yes, our comprehensive form can be adapted for auto accidents, slip & fall cases, workplace injuries, medical malpractice, product liability, and other personal injury matters. It includes sections for different accident types and injury scenarios.

Checklist

Personal Documents

Government-issued photo identification (driver's license or passport)
Required

Clear, legible color copy or original required for client identification and case file documentation.

Supporting Evidence

Official incident or police report detailing the accident
Required

Complete, certified report from the relevant authority including date, time, location, involved parties, and officer's signature.

All written correspondence with insurers and opposing parties
Required

Include demand letters, claim forms, denial notices, and emails. Originals or complete digital copies.

Signed, dated witness statements

Notarized statements on official letterhead preferred. Include contact info, detailed account of incident, and relationship to client.

Photographs of injuries, accident scene, and property damage
Required

High-resolution color photos with date/time stamps. Digital files preferred. Provide context and full view of damages.

Medical Documentation

Comprehensive medical records related to the injury
Required

Include ER records, physician notes, diagnostic imaging, and treatment plans. Certified copies covering all care from the date of injury through present.

Financial Documents

Itemized medical bills and proof of payment
Required

All invoices and receipts from healthcare providers detailing services rendered, dates, and amounts.

Employer verification of lost wages or work restrictions

Letter on company letterhead, signed by HR or supervisor, specifying dates missed, wage rate, and work limitations.

Insurance Documentation

Relevant insurance policy documents (auto, health, liability)
Required

Complete declarations page and policy coverage details. Clear, legible copies for coverage verification.

Legal Forms

Records of prior personal injury or insurance claims

Certified copies preferred. Include claim numbers, dates, and outcomes.

Signed authorization to release medical and insurance information
Required

Must be signed and dated by client within last 60 days. Enables lawful information gathering from medical providers and insurance companies.