ATTORNEY CLIENT INTERVIEW FORM

ATTORNEY CLIENT INTERVIEW FORM

It is important to be prepared for new client interviews. If you don’t have a check list or an interview form you may forget to ask important questions or get the information you need. In addition, after you accept a case and spend time working on it, you are subject to changing  your initial impression of the client and your evaluation of the time. It is helpful to have a record of your first impressions and evaluation. Here is an example of an initial interview form to give you an illustration of what is appropriate for your office and your practice.

ATTORNEY INITIAL CONTACT INFORMATION

NATURE OF CASE:

(  ) Malpractice (  ) Auto  (  ) Product (  ) Death (  ) Other ______________________

Date of Injury/Death:_________________       Place                                                                   

Nature of Injuries:                             ___________________________________

INFORMATION ABOUT CLIENT: (See Receptionist Form)

Name__________________________ Internet E-mail_     _________________________

POTENTIAL DEFENDANT INFORMATION

(1) DEFENDANT                                                     CITY                                             Insurance Co.:                                          Insurance Adjuster                         

(2) DEFENDANT                                                  CITY                                             Insurance Co.:                                                     Insurance Adjuster                   

(3) DEFENDANT                                                                            CITY                           Insurance Co.:                                                    Insurance Adjuster                

(4)        (OTHERS: Use reverse side)

CLIENT INSURANCE

(1)  Medical Insurance                                                                                              

(2)  L&I Claim.                                                                                                              

FACTS

Explanation of how injury occurred (draw diagram on following page):__________  _____________________________________________________________

NEGLIGENCE CLAIMED

___________________________________________________________________________                                                                                                                                                                                                                                                                                           

NATURE OF INJURIES

Description of Initial Injury___________________________________________________                                                                                                                                                                                                                                                                                                                           Description of Present Condition_____________________________                                                                                                                                                                                                                                                                                                                                                          Doctor’s Prognosis________________________________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                  Recommended Treatment or Surgeries_______________________________________                                                    

OUT OF POCKET EXPENSES

$                                                          Total Property Damage

$                                                          Total Medical

$                                                          Total Past Wage Loss

$                                                          TOTAL OF ALL LOSSES

$                                                          Estimated Future Wage Loss

$                                                          Estimated Future Medical

$                                                          Estimated Other

$                                                          TOTAL FUTURE

Information Regarding Out-of-Pocket Expenses                                             

_______________________________________________________________________                                                                                                                                                                                                                                                                                 __________

PREEXISTING MEDICAL CONDITIONS OR INJURIES

TREATING DOCTORS

(1)  Name                                      City               __            Specialty                        

(2)  Name                                            City                             Specialty                    

(3)  Name                                            City                             Specialty                    

(4)  Name                                             City                             Specialty                    

(5)  Name                                              City                             Specialty                    

HOSPITALS

(1)  Name                                                       City                             Dates                          Reason                                                                                                            

(2)  Name                                                       City                             Dates                          Reason                                                                                                                     

(3)  Name                                                       City                             Dates                           Reason                                                                                                                            

KEY WITNESSES

Doctors/Nurses_______________________________________________________                                                                                                                                

Eye Witnesses___________                                                                                

Other Witnesses ___________________________________________________________

SETTLEMENT OFFERS

Offer Received $                                     How Given (writing, oral, etc.)       

ADVICE GIVEN CLIENT

(   ) Statute of Limitations

(   ) Need for Probate and/or Guardianship

(   ) Need for Filing Tort Claim and Effect of same

(   ) Counterclaim for unjustified lawsuit

STATUS

  • COPY MADE OF DRIVER=S LICENSE
  • RETAINER SIGNED
  • PRESENT STATUS                                                                                                   

INTERVIEWER EVALUATION

Persons Interviewing                                                                                                                 

( ) CLEAR LIABILITY
( ) ABOVE AVERAGE
( ) AVERAGE LIABITY
( ) BELOW AVERAGE
( )MAJOR DAMAGES
( ) ABOVE AVERAGE
( ) AVERAGE DAMAGES
( ) BELOW AVERAGE

Comparative negligence evaluation ______________________________________

Recommendation re accepting case______________________________________  

Potential Settlement Value Range $_____________________________________________                                                         

Potential Jury Value Range $__________________________________________________

CLIENT IMPRESSION

(   )  Excellent     (   )  Above Average     (   )  Average     (   )  Below Average     (   )  Poor

PLAN FOR FILE

The following is the recommended plan for this file:___________________________

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