Personal Injury Intake Forms & Client Questionnaires

The client who walks into your office after a rear-end collision on Route 17 needs a different intake than the one who slipped on a wet floor at a grocery store. Both are personal injury cases, but the facts you need to capture at first contact are completely different. The auto accident case needs the other driver's insurance, a police report number, and whether the client went to the ER or started treatment with a chiropractor three weeks later. The slip-and-fall needs the property owner's identity, whether an incident report was filed, who witnessed it, and whether the hazardous condition was documented before your client hit the ground. A generic legal intake form captures neither.

The Personal Injury intake form follows the standard 3-page litigation format and is designed by a licensed attorney admitted in New Jersey and New York. It captures accident type — motor vehicle accident, truck accident, motorcycle, pedestrian, bicycle, slip and fall, premises liability, dog bite, construction accident, product liability, medical malpractice, and wrongful death. For each type, it pulls the right details: intersection and road conditions for auto cases, property address and condition descriptions for premises cases, product name and manufacturer for defective product claims.

The Timeline That Makes or Breaks the Case

PI cases live and die on the medical treatment timeline. Insurance adjusters and defense attorneys look for gaps in treatment to argue that the client was not really injured or that subsequent treatment was unrelated to the accident. The intake form captures the medical timeline from day one: date of first treatment, ER visit details, treating physicians, specialists seen (orthopedist, neurologist, pain management), diagnostic imaging (X-ray, MRI, CT), physical therapy frequency, and whether treatment is ongoing or the client was discharged. It also captures prior injuries to the same body parts — a critical fact that every defense attorney will dig for in discovery.

The form includes fields for lost wages, employment status at the time of the accident, employer name, hourly or salary rate, and days missed from work. It captures health insurance information (because medical liens are coming), auto insurance policy limits and PIP/MedPay coverage, and whether the client has UM/UIM coverage if the at-fault driver was uninsured or underinsured. These are facts you need before you send the first letter of representation, not six months into the case when you are trying to evaluate settlement value.

Intake vs. Client Questionnaire

The intake form is your internal case-opening document. Your paralegal fills it out during or after the initial consultation. It includes the litigation stage, assigned attorney, court and venue information, opposing counsel if known, and a case summary section. The client does not sign it. The companion client questionnaire is what you give the client — it asks them to describe the accident, list all injuries, identify all treating physicians, and authorize release of medical records. It includes a representation agreement acknowledgment and signature block.

Statute of Limitations and Case Screening

Every PI firm has turned down cases that sounded viable on the phone and turned out to have fatal problems — the statute had already run, the client had a prior claim for the same injury, or liability was nowhere near as clear as the client described. The intake form includes fields for date of incident, date the client first contacted your office, applicable statute of limitations deadline, and a case-screening checklist: clear liability, documented injuries, insurance coverage, prior representation, and prior claims history. Capturing these at intake means you make the sign-up decision with real information, not a hunch.

Pricing

Each form is $19.99 for the complete set (intake + questionnaire), $14.99 for intake only, or $9.99 for questionnaire only. All PDFs are fillable in Adobe Reader, password-protected against editing, and carry the CONFIDENTIAL — ATTORNEY-CLIENT PRIVILEGE stamp.

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