top of page
Hands On Steering Wheel_edited.jpg

Auto

Confidential Intake Form
Plaintiff

Information Regarding Plaintiff¹

Information Regarding Plaintiff’s Counsel

Information Regarding Opposing Side

Did they agree to participate in InstaResolve?

Information Regarding The Accident²

Was there a police report?
Did the police ascribe fault?

Information Regarding Property Damage

Type of vehicle.

Describe type of damage and amount.

Has property damage been paid
Should property damage be included in InstaResolve proposal?

Information Regarding Injuries

Did these injuries resolve?

Information Regarding Medical Treatment³

Information Regarding Past Medical Bills

Lien?
Lien?
Lien?
Lien?
Lien?
Lien?

Information Regarding Lost Earnings

Is there a lost earnings claim?

If yes, what is the amount of lost earnings claimed?

Information About Impact on Life Activities

Plaintiff’s Settlement Demands

CCP 998?
CCP 998?
CCP 998?
CCP 998?

Settlement Offers

CCP 998?
CCP 998?
CCP 998?
CCP 998?

Other Information

Upload Documents
Upload Images
Upload Videos

Thanks for submitting!

1. Please fill out separate intake sheets for each Plaintiff.

2. If desired, upload Brief with additional information, photo(s)/video(s).

3. Upload medical records/reports if desired.

bottom of page