About this template
A personal injury intake form is an essential tool used by law firms to gather critical facts, client details, and preliminary case information during the initial consultation stage. This comprehensive questionnaire streamlines the onboarding process by capturing everything from basic contact information and emergency contacts to detailed accident specifics, medical treatment history, insurance coverage details, and lost wage information.
Using Doc2Form to deploy this template enables legal professionals to collect structured, accurate data from new clients before their first meeting, saving valuable time during consultations. By organizing complex information upfront—such as defendant details, police report statuses, and healthcare provider information—your legal team can evaluate claims faster and begin building a stronger case immediately. The form reduces administrative friction, minimizes data entry errors, and ensures no critical detail about the incident is missed.
Key features
- Collect comprehensive client and contact details in a single structured submission.
- Capture precise accident timelines, locations, and narrative descriptions.
- Gather vital insurance policy, claim number, and adjuster contact details.
- Document medical treatment facilities, treating physicians, and injury history.
- Record employer details and lost wage information for economic damage claims.
Use cases
- New client onboarding for personal injury law practices.
- Initial auto accident claim evaluation and insurance verification.
- Gathering pre-existing injury and medical treatment histories.
- Compiling defendant and witness information for active case files.
What this form collects
- Full Name (Short answer)Enter your first, middle, and last name.
- Contact Number (Short answer)Primary phone number where we can reach you.
- Email Address (Short answer)Where we can send updates and documents regarding your case.
- Residential Address (Paragraph)Street address, city, state, and zip code.
- Date of Birth (Date)MM/DD/YYYY format.
- Marital Status (Dropdown)Select your current marital status.
- Accident Date & Time (Date)When did the incident occur?
- Accident Location (Short answer)Street intersection, highway, or specific address where the accident happened.
- Accident Description (Paragraph)Describe in your own words how the accident happened.
- Police Investigation Status (Multiple choice)Was a police report filed for this incident?
- Incident / Police Report Number (Short answer)Provide the report number if available.
- Injuries Sustained (Paragraph)List all injuries you suffered as a result of the accident.
- Treating Physician or Facility Name (Short answer)Name of the hospital, clinic, or doctor who treated your injuries.
- Insurance Company Name (Short answer)Your auto or relevant insurance provider.
- Policy Number & Claim Number (Short answer)Enter your policy number and claim number if already assigned.
- Missed Work Status (Multiple choice)Have you missed work as a result of your injuries?
- Employer Name (Short answer)Name of your employer for lost wage verification.
- Defendant Information (Paragraph)Provide the name, contact info, and insurance details of the other party involved, if known.
- Additional Notes (Paragraph)Share any other important details or questions for our legal team.
FAQ
How can I customize this personal injury intake form for my law firm?
Once you convert this template using Doc2Form, you can easily open it in Google Forms to add, remove, or reorder questions to match your firm's specific intake workflow.
Can clients complete this form on their mobile devices?
Yes. Google Forms are fully responsive and optimized for smartphones, tablets, and desktop computers, making it easy for clients to submit information from anywhere.
Where do the form submissions go?
All responses are automatically saved to a connected Google Sheets spreadsheet, allowing your legal team to organize, review, and export client data securely.
Is it possible to collect file attachments like accident photos or police reports?
While Google Forms handles file uploads directly when configured, you can also ask clients to paste links to cloud folders (Google Drive, Dropbox) or email supporting documents separately.
How does Doc2Form help me set up this form?
Doc2Form instantly translates this structured template into a ready-to-use Google Form with zero manual copy-pasting required, letting you start collecting client information in seconds.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.