pi-intake-form

name	pi-intake-form
title	Personal Injury Client Intake Form
description	Drafts a structured personal injury client intake form for initial consultations covering client identification, incident details, injury/treatment history, insurance, prior legal history, and authorizations. Supports conflict checking, case evaluation, and engagement setup. Use when onboarding a new PI client, creating intake questionnaires, or building pre-filing client records. Trigger keywords: personal injury intake, client onboarding, PI questionnaire, accident intake, injury claim intake.
author	CaseMark
author_url	https://github.com/CaseMark/skills/tree/main/skills/legal/pi-intake-form
license	Apache-2.0
version	0.1.0
execution_mode	open
jurisdiction	us
practice	personal-injury
language	en
tags	["checklist","drafting","litigation"]

Personal Injury Client Intake Form

Drafts a fillable intake form for prospective personal injury clients that supports conflict checking, statute-of-limitations tracking, case evaluation, and engagement setup.

Prerequisites

1. Jurisdiction — state of incident and client residence (determines SOL, comparative fault rules, damage caps, no-fault requirements).
2. Firm details — firm name, address, contact info, fee structure (contingency percentage, cost advancement policy).
3. Documents already provided — accident reports, medical records, photos, correspondence — to pre-populate fields and generate follow-up questions.

Output Structure

Generate a fillable intake form with the following sections in order. Calculate and flag the statute-of-limitations deadline prominently at the top based on jurisdiction and incident type.

1) Client Identification

Field	Notes
Full legal name	As on government ID
Former names / aliases	For conflict checking
Date of birth
SSN (last 4 only)	Include privacy notice
Residential address
Mailing address (if different)
Marital status / spouse name	Loss-of-consortium relevance
Dependents (names, ages)	Wrongful death relevance

2) Contact & Communication

Field	Notes
Primary phone	Mobile / landline
Secondary phone
Email (personal / work)
Preferred contact method	Phone / email / text / portal
Do NOT contact at	Confidentiality concerns
Text/email consent	Security limitation warning
Authorized recipients	Others permitted case info
Interpreter / accommodation	Language or accessibility needs

3) Incident Details

• Date of incident — flag SOL deadline (verify jurisdiction-specific period)