Last updated: September 12, 2026
What a personal injury intake form captures
A personal injury intake form captures the caller's identity and callback number, the incident date, location, and how it happened, injuries and treatment so far, liability details, every insurance policy in play, prior representation, and the parties needed for a conflict check. The form below marks which fields have to be captured on the call.
Most published intake forms are ordered the way a database wants them, which puts address, date of birth, and marital status on the first screen. Somebody calling twenty minutes after a collision hears that as a customer record being opened, and the caller hangs up either way if the first two minutes feel like paperwork. The form below runs in the order the questions get asked on a live call.
The intake form
Two of the columns do work that the intake forms circulating as PDFs leave out. Capture says whether a field has to come out on the live call or can wait for the signed packet. Flag marks gates and signals: a gate is a field whose answer can end or reroute the intake under your firm's own screening rules, and a signal is something the reviewing attorney will want in front of them before they decide anything. Nothing on this page is legal advice, and no field here says what a matter is worth.
| Section | Field | Type | Capture | Flag | Why it is asked |
|---|---|---|---|---|---|
| Reach back | Caller name and whether they are the injured person | Text | Live | A call that drops in minute two leaves you nothing without this | |
| Reach back | Callback number, read back to the caller digit by digit | Phone | Live | A number off by one digit ends the relationship before it starts | |
| Reach back | Relationship to the injured person | Text | Live | A spouse or a parent calling changes who can authorize what | |
| Reach back | Whether the caller can talk freely right now | Yes / No | Live | Hospital rooms and body shops are not private and the answer sets the next step | |
| What happened | The caller's own account of what happened, in their words | Long text | Live | Every other field on this form is a follow up question to this one | |
| What happened | Incident date | Date | Live | Gate | The age of the matter sets the review priority and feeds the deadline check somebody qualified runs later |
| What happened | Incident type, such as motor vehicle, premises, or animal | Picklist | Live | Gate | Firms take some claim types and refer the rest out |
| What happened | City, county, and state where it happened | Text | Live | Gate | Jurisdiction decides whether your firm can take it and who would handle it |
| What happened | Names of everybody else involved | Text | Live | Conflict parties come out here before the facts go any deeper | |
| Conflict and prior representation | Businesses, employers, or property owners connected to the incident | Text | Live | Conflicts run through companies as often as they run through people | |
| Conflict and prior representation | Insurance carriers named so far | Text | Live | Carriers belong on the conflict list at any firm that also does defense work | |
| Conflict and prior representation | Whether another firm is engaged on this matter | Yes / No | Live | Gate | Contact with a represented person is the line nobody wants to cross |
| Conflict and prior representation | Prior claims or prior representation | Text | Follow up | Signal | The history surfaces later anyway and the attorney would rather hear it from you |
| Injuries and treatment | Injuries the caller describes | Long text | Live | The words the caller uses are worth keeping even when a chart later says something different | |
| Injuries and treatment | Whether they have been treated at all | Yes / No | Live | Gate | An untreated caller is a different conversation and often a different call to make |
| Injuries and treatment | Date of first treatment | Date | Live | Signal | A long gap between the incident and the first visit is something an attorney reads before the call back |
| Injuries and treatment | Providers seen so far and whether treatment is ongoing | Text | Follow up | Signal | Records requests start from this list and ongoing care changes the timeline |
| Liability indicators | Police or incident report number and the agency that wrote it | Text | Follow up | Signal | The report is the fastest independent version of the same story |
| Liability indicators | Whether a citation was issued to anybody | Yes / No | Live | Signal | The caller usually knows this on the call and rarely volunteers it |
| Liability indicators | What anybody said about fault at the scene | Long text | Live | Signal | Admissions fade from memory faster than anything else on this form |
| Liability indicators | Witnesses and how to reach them | Text | Live | Signal | Witnesses get harder to find every week you wait |
| Liability indicators | Photos, video, or dashcam footage the caller already has | Yes / No | Live | Signal | Ask on the call because a camera roll gets cleared out eventually |
| Insurance and coverage | The other side's carrier and claim number | Text | Follow up | Signal | Everything the firm does with the carrier starts from the claim number |
| Insurance and coverage | The caller's own auto or property policy | Text | Follow up | Their own policy can be the coverage that responds first | |
| Insurance and coverage | Uninsured and underinsured motorist coverage | Yes / No / Unknown | Follow up | Signal | Most callers do not know and the declarations page settles it |
| Insurance and coverage | Medical payments coverage or health insurance | Text | Follow up | How the treatment gets paid for in the meantime is a real question for the caller | |
| Insurance and coverage | Whether a recorded statement has already been given to an adjuster | Yes / No | Live | Signal | The attorney needs to know this before anybody talks to the carrier again |
| Deadline flags | Whether a government or public entity is involved | Yes / No | Live | Signal | Claims that touch public bodies carry their own notice steps for a lawyer to handle |
| Deadline flags | Date the injury was discovered, where that differs from the incident date | Date | Live | Signal | Some matters run from discovery rather than from the event |
| Deadline flags | Any claim, notice, or lawsuit already filed | Yes / No | Live | Signal | A matter already in motion goes to an attorney today rather than into a queue |
| Employment and lost income | Employer and job at the time | Text | Follow up | The work the caller does decides what the injury actually cost them | |
| Employment and lost income | Work missed so far and whether pay records can be produced | Text | Follow up | Signal | A number with no document behind it is a number that gets argued |
| Referral and contact | How the caller found the firm | Picklist | Live | Marketing spend gets judged on this field and intake is where it gets filled in wrong | |
| Referral and contact | Email and mailing address | Text | Follow up | The packet goes nowhere without it | |
| The appointment | Consultation day and time, said back to the caller | Date and time | Live | A time nobody repeated back is a time nobody wrote down | |
| The appointment | Who will call the caller and by when | Text | Live | This is the promise that gets broken most | |
| The appointment | What the caller is sending in and where to send it | Text | Live | The packet arrives when somebody names the address out loud on the call |
Thirty seven fields, ten sections, and a reason attached to every line so your firm can cut the questions that only exist because the last form had them.
The fields that decide whether the call continues
Five fields carry a gate: the incident date, the incident type, the jurisdiction, whether the caller has been treated at all, and whether another firm is already engaged. All five sit in the first third of the call, which is the whole point of putting them there. A call that should end at minute three ends at minute three, rather than at minute twenty after the caller has recited an employer address and a health plan number for a matter the firm was never going to take.
A gate routes rather than rejects. The specialist reads the answer and applies your screening rule, and the call goes to a referral, to a different practice group, or to an attorney who makes the call. Deciding whether a matter has merit belongs to a lawyer, and the form should not read as though the specialist is doing it.
Download the form
The form downloads as a CSV or a spreadsheet, with nothing in front of either. Both carry a field schema rather than a scored rubric, so an import into your case management system brings columns and reasons instead of point values. Scoring lives on the scorecard that grades the call, and every template we publish sits on the hub.
Asking the conflict check questions first
The names of everybody else involved sit in the middle of the incident section rather than at the end of the form. Firms that run the check before case details are taken want those names early, and the caller is already naming the other driver in the first pass of their story anyway, so the question costs nothing where it sits.
Phrasing is what makes it land. An intake specialist who opens with a records request sounds like a claims department, and the caller has just described the worst week of their year. The move that works is acknowledging the injury, then asking for a spelling: "I'm sorry, that sounds awful. Before you tell me the rest, can you spell the other driver's name for me? Every new call gets checked against the firm's client list first."
Capturing dates without calculating deadlines
The incident date and the jurisdiction are captured so somebody qualified can work out a deadline later. That calculation happens somewhere else, and the answer never gets read out to a caller on this call. A specialist who tells a caller they have plenty of time has made a statement the firm now owns.
What a specialist can say is what they are doing with the date. "I have the date of the collision and the county it happened in, and both of those go to an attorney today" is accurate, useful to the caller, and safe. Two other fields feed the same check without going near a calculation: the discovery date, where the injury showed up later than the event, and whether a public body is involved, which carries notice steps that a lawyer handles.
Keeping the form short enough to finish on the call
Twenty seven of the thirty seven fields are marked live, which looks heavy until you read what is in the other ten. Records, policy numbers, employer details, and a mailing address all survive in documents, so the packet picks them up later. A witness's phone number and what the other driver said at the scene live in one place only, which is the head of the person on the phone right now, and both degrade by the day.
Say a specialist averages eleven minutes on a new intake call. Twenty seven live fields at roughly fifteen seconds each is under seven minutes, and that leaves four for the part where the caller tells the story without being interrupted. That arithmetic is a hypothetical rather than a benchmark, and your own recordings will tell you the real split.
We had prior claims marked live in the first pass of this form and moved it. A caller who has just been asked whether they have done this before tends to hear an accusation, the specialist tends to rush past the answer, and the attorney gets it in the second conversation anyway with better context around it.
Checking the form against the recording
A completed intake form is a claim about what happened on the call. The recording is what happened on the call. Putting the two side by side is the most useful check an intake program runs, because it catches capture errors that no amount of coaching would surface.
The mismatches follow a pattern. A name gets spelled one way on the recording and lands another way in the field, or a callback number the caller corrected at minute six goes in as the first version. Dates are the expensive ones: somebody says "the Tuesday before Thanksgiving" and the form carries a date nobody ever confirmed out loud. None of that shows up in a conversion report, and all of it shows up when somebody reads the form with the audio open.
CallSniper makes that check searchable, so searching every intake call for the conflict question or the callback read back stops being a listening exercise. Rule based criteria hold up well against a transcript and anything turning on tone gets shakier, which Aircall and StackAI both note about automated scoring. A form records what was asked and says nothing about how it sounded, and our base model learned its vocabulary on answering service calls, so a firm's own terminology may need a pass before the flags are worth much.
The handoff
A finished form is worth whatever the next hour does with it. The part of intake nobody writes down is what happens between the call ending and an attorney seeing the thing, and that gap is where most of the losses actually happen. A complete form sitting in a shared inbox for two days loses the case to the firm that called back in an hour.
So write the handoff into the form itself: where it lands, who owns it by title rather than by whoever happens to be around, and what a gate flag does on arrival. A matter flagged for a public entity, an existing filing, or an incident date somebody should look at goes to an attorney the same day rather than into the queue in the order it arrived.
That hour is our own working target rather than a published figure. Speed numbers circulating in legal intake mostly trace back to sources we could not stand behind when we went looking on 2026-09-08, so set the target off your own callback times and hold to it.
To see the gap between the forms and the calls at your own firm, we score a month of the intake recordings you already keep against your own criteria for a fixed pilot price. That is the work behind QA for personal injury intake and behind law firm intake outside personal injury. Start with the calls that ended without a consultation booked.
Frequently asked questions
What questions should be on a personal injury intake form?
Ten groups cover it: reach back details, what happened, conflict parties and prior representation, injuries and treatment, liability indicators, insurance and coverage, deadline flags, employment and lost income, referral source, and the appointment. Five fields carry a gate, which is why they sit in the first third of the form rather than wherever a database would file them.
How long should an intake call take?
Time it against your own recordings rather than a figure from a conference talk. The number worth watching is the live capture split: twenty seven of the thirty seven fields here have to come out on the call because they only exist in the caller's memory, and the other ten come out of documents afterward.
What information do you need from a personal injury client?
The incident date, location, and mechanism tell the firm what kind of matter it is and where it would be handled. Injuries and treatment to date, the liability details, and every policy involved are what an attorney reads before deciding whether to take the call further. Conflict parties are captured separately because the check runs before case details go any deeper.
Should intake specialists ask about prior claims?
Yes, and the phrasing and the timing are your firm's policy to set. The question lands badly early in a first call, where it reads as suspicion, so this form marks it as a follow up field for the second conversation. Nothing about the answer decides anything on its own.
What is the difference between an intake form and an intake scorecard?
The form captures the data, and the scorecard that grades the call grades the conversation where the form got filled in. A specialist can complete every field on this page and still lose the caller, which is exactly what the scorecard is for. Running both and comparing them is how capture errors turn up.
Sources
- Trinsic feature sheet and call notes, 2026-08-27 and 2026-09-03. Verified internally.
- Aircall and StackAI on rule based criteria scoring more reliably than tone. Third party, unverified.
- Base model trained on answering service calls, from client call notes of 2026-09-10. Unverified, pending confirmation with Trinsic.
- Speed to lead figures circulating in legal intake. Third party, unverified, and not used on this page.
- The field list, the gate and signal marks, the live capture split, and the one hour callback target. Editorial judgment for this template.