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:___________________________