Personal Injury Attorney Intake Form

Provided by 1 833 Claim Me LLC D/B/A Claim Me

Please answer the questions below and a member from our team will be in touch.

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1. Full Name *

Inquiring attorney’s full name

Law Firm Name *

Inquiring law firm

Address

Address Line 2

City

State

clients? 4. attorneys

Zip Code

Phone Number

Please enter a valid phone number.

Email Address *

Website

Bar License Number

In good standing? *

• Yes
• No

Languages Spoken in Office

2. Practice Areas – Please indicate which areas you actively handle (check all that apply):

• Auto Accidents
• Motorcycle Accidents
• Pedestrian/Bike Accidents
• Slip & Fall / Premises Liability
• Dog Bites
• Wrongful Death
• Catastrophic Injury
• Property Damage (Auto)
• UM/UIM Claims
• Medical Malpractice (optional)

3. Case Handling Preferences – Do you accept cases at the pre-litigation stage? *

• Yes
• No

Years of experience managing and settling personal injury claims?

Number of attorneys in your firm?

Do you handle litigation in-house or refer it out?

• In house
• Refer out

Average case volume handled monthly

Minimum case value accepted (if any)

Do you accept soft-tissue injury cases under $15k? *

• Yes
• No

Do you handle property damage for clients? *

• Yes
• No

4. Fee & Referral Structure – Standard contingency fee (pre-lit)

Contingency fee (litigation)

5. Case Management – Average response time to client inquiries

Number of attorneys handling PI cases

Do you give status updates to referral partners? *

• Yes
• No

Do you provide post-resolution reports? *

• Yes
• No

6. Does your firm have any unique strengths, resources or relationships (e.g., with medical providers, chiropractors, lien negotiators, experts) that differentiate it from other PI firms?

By checking the box below, you confirm that all information provided is accurate and that you are currently licensed and in good standing to practice law. *

• Confirm

Submit