Personal Injury Intake Questions
Customize intake questions for accident and injury cases. Include incident details, injury descriptions, and insurance information. Download as PDF or DOCX.
What this includes
- Incident date, type, and location
- Injury descriptions and severity
- Medical treatment history
- Insurance information for all parties
- Police report and witness details
Customize Questions
Preview
17 questionsPersonal Injury Intake Questionnaire
17 questions across 4 sections
Please complete all fields below. Required questions are marked with an asterisk (*).
Contact Information
1. Your Full Name*
2. Email Address*
3. Phone Number*
4. Current Address*
Incident Details
5. Date of Incident*
6. Type of Incident*
7. Location of Incident*
8. Description of What Happened*
Injuries & Medical Treatment
9. Describe Your Injuries*
10. Have you received medical treatment?
11. Medical Treatment Details
12. Are you still receiving medical treatment?
Insurance & Additional Info
13. At-Fault Party's Insurance Company (if known)
14. Your Insurance Company
15. Was a police report filed?
16. Have you been contacted by another attorney?
17. Any Additional Information
This questionnaire is for informational purposes only and does not constitute legal advice.
How to use this tool
Review the questions
Browse through the pre-built sections and questions tailored for your practice area.
Customize as needed
Toggle questions on/off, edit the text, mark as required, or add your own questions.
Download and distribute
Export as PDF to print, or DOCX to edit further. Share with clients during consultations.
Frequently asked questions
What are the most important questions for personal injury intake?
Critical questions include the incident date (for statute of limitations), type of accident, injuries sustained, medical treatment received, and insurance information for all parties. This template covers all essential PI intake fields.
Why is the incident date so important?
The incident date determines the statute of limitations for filing a claim. In most states, you have 2-3 years from the date of injury. Capturing this accurately at intake is essential for case evaluation.
Should I ask about prior attorneys?
Yes. Knowing if the client has already spoken with other attorneys helps you understand the case history and any prior negotiations. This template includes a question about prior attorney contact.
Is this tool free to use?
Yes. This intake questions builder is completely free. Customize the questions, download as PDF or DOCX, and use them in your practice. No account required.
Can I edit the questions?
Yes. Click on any question text to edit it inline. You can also toggle questions on/off, mark them as required, and reorder them within sections.
What file formats can I download?
You can download your customized intake questionnaire as either a PDF or DOCX file. Both formats are ready to print or share with clients.
Do you save my customizations?
No. This tool does not save or store any data. Your customizations exist only in your browser session. Download your questionnaire before leaving the page.
Can I collect these forms online instead of on paper?
Yes. Weavelyn's intake software lets you create online forms based on these templates. Clients fill them out securely, and you receive submissions in a centralized dashboard.
Ready to streamline your personal injury intake?
Turn this questionnaire into an online form. Clients submit securely, and you manage everything in one dashboard.