By the Templateez Team · Licensed Attorney · July 2026

Personal Injury Intake Forms: A Field-by-Field Guide

Most PI attorneys have been burned by an intake that missed something. Maybe it was a prior injury the client forgot to mention, or a second insurance policy nobody asked about, or the fact that the accident happened at work — which means the case is really a workers' compensation matter, not a straight negligence claim. These gaps do not show up during the first phone call. They show up three months later when the adjuster pulls medical records that predate the accident, or when defense counsel files a motion for summary judgment based on facts you never collected.

A personal injury intake form exists to prevent that. Not to impress the client, not to look professional (though it does both), but to force a structured collection of every detail that affects liability, damages, and case value before memory fades and documents get lost.

The accident itself

This sounds obvious, but a surprising number of intake forms handle it poorly. They have a single text box labeled "describe the accident." That is a journal prompt, not an intake field. You need structured data: date, time, location (exact address or intersection), weather conditions, type of incident (motor vehicle, slip and fall, premises liability, product defect, dog bite, medical malpractice — the list matters because each has its own liability framework), and whether a police report or incident report was filed.

For motor vehicle accidents specifically, you need the direction of travel for each vehicle, the point of impact, whether airbags deployed, whether the client was wearing a seatbelt, and the make/model/year of every vehicle involved. These are not trivial details. Seatbelt use affects comparative fault in many jurisdictions. The point of impact determines which occupants were likely injured and how. An adjuster who sees "rear-end collision" but no specifics about speed or impact will lowball the claim every time.

Injury type and medical treatment

Your intake should distinguish between injuries reported at the scene, injuries discovered in the emergency room, and injuries that developed over the following days or weeks. The timeline matters enormously for causation arguments. A herniated disc diagnosed six months post-accident is much harder to tie to the collision than one found on an MRI taken the next day.

Capture the treating providers: ER, primary care physician, orthopedist, neurologist, chiropractor, physical therapist. Get names, addresses, and approximate dates of first visit. You will need signed medical authorizations for each one, and starting that process at intake instead of three weeks later saves real time. The client who walks in knowing they saw "a doctor" but cannot remember which hospital is common. Your form should ask specifically: which emergency room, which ambulance company, which follow-up doctors.

Pre-existing conditions deserve their own section. Not because they destroy the case — the eggshell plaintiff doctrine protects your client — but because you need to know about them before the defense does. A client with a prior back surgery who reinjures the same area has a legitimate claim, but you need to frame it correctly from day one. The worst way to learn about a prior injury is from the defense's medical expert report.

Insurance information

This section needs to cover more than most attorneys think. You need the at-fault party's insurance carrier and policy number (if known), the client's own auto insurance carrier and policy number, the client's health insurance carrier, and whether the client has any umbrella or excess coverage.

For auto accidents, ask about uninsured/underinsured motorist coverage on the client's own policy. In hit-and-run cases or cases where the at-fault driver has minimum limits, UM/UIM coverage is often the only path to adequate compensation. Many clients do not know whether they have it. The policy declarations page answers the question, and asking for it at intake is much better than discovering six months in that your client's own carrier owes $250,000 in UIM benefits that nobody claimed.

Medical payments coverage (MedPay or PIP, depending on the state) is equally important. It pays regardless of fault, which means it can cover treatment costs while the liability claim is still being negotiated. Clients in no-fault states may not even realize their insurance claims process differs from what they see on television.

Statute of limitations and key dates

Every jurisdiction has its own statute of limitations for personal injury claims. In New Jersey, it is two years from the date of injury. In New York, it is three years for most torts. Government entity claims have much shorter notice-of-claim deadlines — 90 days in New Jersey, which is easy to miss if the client waits a month before calling a lawyer.

Your intake form should capture the accident date, any government entity involvement (municipal bus, state highway, federal agency), and flag whether a notice of claim has already been filed. A separate field for "next critical deadline" keeps the most urgent date visible on the face of the file.

Liability theory and fault

This is where a profession-specific intake form earns its keep over a generic one. You need fields for: the client's description of how the other party was at fault, any traffic citations issued, whether the client bears any comparative fault (and if so, what percentage they estimate), whether the premises owner had notice of the hazard (for slip-and-fall cases), and whether a product defect is alleged.

Comparative fault is critical in states that follow modified comparative negligence (like New Jersey, which bars recovery if the plaintiff is more than 50% at fault). You do not want to discover your client ran a red light from the police report you finally requested two months after intake. Asking about it directly, on the form, at the first meeting, forces the conversation.

Damages and lost wages

Beyond medical expenses, your intake should capture: lost time from work (dates and employer), current employment status, hourly rate or salary, whether the employer has a short-term disability policy, any out-of-pocket expenses (prescriptions, medical equipment, transportation to appointments), and property damage.

For clients who are self-employed, lost income documentation is more complicated. Tax returns, profit and loss statements, and client invoices may all be relevant. Your intake should ask about employment type (W-2 vs. 1099 vs. business owner) so you know what documentation to request early.

Witnesses and evidence preservation

Names and contact information for every witness the client knows about. This includes passengers in both vehicles, bystanders, responding officers (badge numbers if available), and anyone the client spoke to after the accident. Surveillance camera locations near the accident scene should also be noted — gas stations, ATMs, and traffic cameras often have footage, but many systems overwrite within 30 days.

Ask whether the client took photos at the scene. Ask whether they posted about the accident on social media (and if so, advise them to stop). Ask whether they gave a recorded statement to any insurance company. Each of these questions addresses a common problem that becomes much harder to manage once the answer is "yes, three months ago."

Prior claims and litigation history

Has the client filed personal injury claims before? If so, how many, what type, and what was the outcome? Prior claims are discoverable and defense counsel will find them. An intake form that asks the question directly gets the honest answer early, rather than the embarrassed admission later. It is not disqualifying — plenty of people are legitimately injured more than once — but you need to know the history to present the current claim credibly.

Who uses these forms

PI attorneys and paralegals, primarily. In a busy practice, the paralegal often conducts the initial intake while the attorney reviews the completed form before the consultation. A structured, fillable PDF makes that handoff clean. The paralegal fills it out during the phone call or in-person meeting; the attorney reads a complete, organized file instead of a stack of handwritten notes.

Legal aid organizations and law school clinics handling tort cases also use them. And insurance defense firms — yes, the other side — use similar forms for their own client intake when an insured is named as a defendant.

For practices that handle both personal injury and other case types, having profession-specific intake forms for each practice area means every new matter starts with the right questions, not a generic form that misses half the relevant fields.