Intake Form

This form will be used to perform a conflict check and an initial assessment of the file. There is no obligation to retain us until a signed agreement is in place. We will contact you at a time indicated by the form and as soon as possible after submission.

"*" indicates required fields

Date Received*

Referred by

Primary Contact Name*

Company Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone # of Primary Contact*

Email of Primary Contact*

URL

Require a Fee Schedule?

Yes

Require an Agreement

Yes

What is the estimated project cost range?

Require a Quote?

Yes

What is the best time to contact you?

Location/Jurisdiction*

Case Name

Legal File #

Client Internal File #

Plaintiff

Client

Defendant

Client

Case Overview*

Question to Answer

Main Injury

Points of Contention

How soon can you provide case materials? Approximate number of Pages in Case Materials? Report deadline?

Notes

Intake Form

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