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.
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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.
Drafts a fillable intake form for prospective personal injury clients that supports conflict checking, statute-of-limitations tracking, case evaluation, and engagement setup.
Prerequisites
Jurisdiction — state of incident and client residence (determines SOL, comparative fault rules, damage caps, no-fault requirements).
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)
Location — street address, city, county, state
Type — motor vehicle, slip/fall, premises liability, product liability, medical malpractice, dog bite, workplace, other
