Get Auto Accident Intake Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Auto Accident Intake Form online
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
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- 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.
- Indicate your marital status and provide your spouse's name and number if applicable. Include two emergency contacts with their names and phone numbers.
- 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.
- Next, fill out the 'Health Insurance Information' section by entering your primary and secondary health insurers along with your member numbers and addresses.
- 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.
- Complete the 'Facts of Accident' section by entering details about the date, time, weather conditions, and any damages to vehicles involved.
- If applicable, provide information regarding any prior accidents or medical history that may relate to the current situation.
- 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!
When you begin to structure your letter, create a short introduction that tells who you are and how you relate to the incident. Also give the date and time that the accident occurred. Use the body of the letter to recount the events leading up to the accident in as much detail as possible, starting at the beginning.
Fill Auto Accident Intake Form
Last Name: First Name: M.I. _____. Name: Spouse's Name: Address: City, State, Zip: Date of Birth: Soc. Sec. COLLISION DESCRIPTION Please describe, to the best of your knowledge, what happened during this collision. Auto Accident Details. Date of Accident: Time Occurred. Your Vehicle Type. 2. Your position in vehicle. 3.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.