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Legal Intake · Popular

Streamline Your Personal Injury Client Intake Process

Efficiently gather client details, incident information, and medical records for personal injury cases with this ready-to-use intake form.

Use This Template Free Preview

Frost theme

formbuilder.ai/f/personal-injury-case-client-intake-documentation-form

Personal Injury Case Client Intake & Documentation Form

Full Legal Name

· · ·

Email Address

· · ·

Phone Number

· · ·

Submit

The Personal Injury Case Client Intake & Documentation Form is a comprehensive tool designed for law firms, legal professionals, and solo attorneys handling personal injury cases. It captures all essential client information—from personal contact details and emergency contacts to a thorough account of the incident, police reports, and witness information—ensuring nothing is overlooked from the very first consultation.

This form is ideal for any legal practice that wants to standardize its client onboarding process, reduce administrative burden, and ensure accurate documentation from day one. By collecting structured data on the type of incident, location, date, and medical treatment received, attorneys can build a stronger foundation for each case and reduce back-and-forth communication with clients.

Using this template saves time, improves data accuracy, and enhances the overall client experience. It can be easily customized to fit your firm's specific needs, embedded on your website, or shared via a direct link—making it simple for new clients to complete before their first appointment.

4 Pages

29 Questions

~10min To complete

Free No credit card needed

Field types Short Text ×5 Yes / No ×5 Long Text ×4 File Upload ×3 Full Name ×2 Phone ×2 Dropdown ×2 Email Address Single Choice Date termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Client Information 8 questions

Client Personal Details

1 Full Legal Name * Full Name

2 Email Address * Email

3 Phone Number * Phone

4 Current Home Address * Address

5 Preferred Contact Method * Single Choice

Emergency Contact

6 Emergency Contact Name * Full Name

7 Emergency Contact Phone Number * Phone

8 Relationship to You * Short Text

Page 2 Incident Details 8 questions

About the Incident

1 Date of Incident * Date

2 Location of Incident (City, State) * Short Text

3 Type of Incident * Dropdown

4 Please describe in detail what happened * Long Text

5 Was a police report filed? * Yes / No

6 Police Report Number (if available) Short Text

7 Were there any witnesses to the incident? * Yes / No

8 Witness Names and Contact Information (if known) Long Text

Page 3 Medical & Insurance Information 7 questions

Medical Treatment

1 Have you received medical treatment for injuries from this incident? * Yes / No

2 List all injuries sustained and treatments received * Long Text

3 Primary Treating Physician / Hospital Name Short Text

4 Are you currently still receiving treatment? * Yes / No

Insurance Details

5 Do you have health insurance? * Dropdown

6 Insurance Company Name & Policy Number (if applicable) Short Text

7 Has any insurance claim been filed related to this incident? * Yes / No

Page 4 Supporting Documents & Legal Consent 6 questions

Upload Supporting Documents

Please upload any relevant documents such as police reports, medical records, photographs of injuries or the scene, insurance correspondence, or other evidence. Accepted formats: PDF, JPG, PNG, DOC.

1 Police Report File Upload

2 Medical Records / Bills File Upload

3 Photos of Injuries or Accident Scene File Upload

Legal Authorization

4 Is there anything else you would like us to know about your case? Long Text

5 I certify that the information provided in this form is true and accurate to the best of my knowledge. I authorize this law firm to obtain relevant medical, employment, and insurance records related to my case. * termsandconditions

6 Client Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.