Get Auto Accident Intake Form

Completing the Auto Accident Intake Form is an important step in the process of seeking legal assistance after an accident. This guide provides clear and detailed instructions to help you fill out the form accurately and efficiently, ensuring that you provide all the necessary information.

Follow the steps to complete the Auto Accident Intake Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by filling in your personal information in the 'Client Information' section. This includes your full name, date of birth, preferred nickname, and contact details such as your phone numbers and email address.
3. Indicate your marital status and provide your spouse's name and number if applicable. Include two emergency contacts with their names and phone numbers.
4. In the 'Employment Information/Work Absence' section, clarify whether you were working at the time of the accident and provide details about your employer, job position, and any wages lost due to the collision.
5. Next, fill out the 'Health Insurance Information' section by entering your primary and secondary health insurers along with your member numbers and addresses.
6. In the 'Accident Information' section, provide details about the accident, including treatment history with health care providers, injuries sustained, and information about the other party involved in the accident.
7. Complete the 'Facts of Accident' section by entering details about the date, time, weather conditions, and any damages to vehicles involved.
8. If applicable, provide information regarding any prior accidents or medical history that may relate to the current situation.
9. Finally, review the entire form for accuracy and completeness. Once you have finished filling it out, save your changes, and choose to download, print, or share the form as necessary.

Start filling out your Auto Accident Intake Form online today to ensure you have the support you need!