Personal Injury Intake Form Template
A free personal injury intake form for law firms. Potential clients describe the accident and injuries, and lead mode shows which cases to call first.
Customize the pages and design to fit your needs.
About this template
Screen every new personal injury inquiry with the accident type, date, injuries, fault and whether they already have a lawyer. Lead mode marks recent cases with treated injuries as hot leads.
Common uses
- Personal injury law firms
- Car accident case screening
- Landing pages for injury ads
Key features
- Accident and injury details
- Photo and report uploads
- Hot lead tagging
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
What kind of accident was it?
Single Choice · Car or truck accident, Slip and fall, Injury at work, Dog bite, Something else
When did it happen?
Single Choice · Within the last month, 1 to 12 months ago, 1 to 2 years ago, More than 2 years ago
Were you hurt?
Single Choice · Yes, and I saw a doctor, Yes, but I haven't seen a doctor, No injuries
Who do you think was at fault?
Single Choice · Someone else, Partly me, Not sure
Do you already have a lawyer for this?
Yes / No
Describe what happened
Long Text
Upload photos or a police report
File · Optional
When is the best time to call you?
Single Choice · Morning, Afternoon, Evening
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
How does lead mode screen injury cases?
It reads the accident date, injuries, fault and whether they already have a lawyer. Recent cases where someone else was at fault and the person saw a doctor come through as hot leads.
Where should a personal injury firm use this form?
Put it on your website, in injury ad landing pages, and in text replies to missed calls, so every inquiry gets screened the same way.
Does submitting the form make someone a client?
No. The thank you message says sending the form does not create a lawyer and client relationship. You decide which cases to take after you speak.