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  • CLIENT INTAKE FORM

    Auto Accident
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  • PLAINTIFF’S INFORMATION

  • EMERGENCY CONTACT (RELATIVE/FRIEND)

  • ACCIDENT INFORMATION (Get copy of exchange/police report)

  • PROPERTY DAMAGE

  • DEFENDANT’S INFORMATION

  • DEFENDANT’S INSURANCE INFORMATION

  • CLIENT’S HEALTH INSURANCE INFORMATION (Upload copy of card)

  • INJURIES/TREATMENT

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  • PRIOR MEDICAL HISTORY

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  • EMPLOYMENT

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