This is a sample of an INFORMATION QUESTIONNAIRE,
That Legal Assistants or Attorneys can have a POTENTIAL CLIENT fill out.

Give the client a few sheets of paper that says the following, and ask them to fill it out and give it back to you

Before a case is taken, the facts are first investigated and analyzed in a preliminary manner. Then if the case is taken by this firm and a written attorney/client fee contract is entered into, we do a further investigation. You are not a client until a written fee contract is signed. Until then nothing you tell us is privileged or confidential.

The investigation, after the fee contract is signed, is to get the facts so that the value of the case, from the standpoint of the extent of damages to you, and the extent of responsibility on the part of those involved, can be determined. Then we can proceed to present your claim in an effective manner. If you become a client, we will tell you how we will proceed to present your claim.

After you become a client, and after we have done an investigation that allows us to negotiate from a position of strength for you, then discussions are had with the defendant's insurance company to negotiate a settlement. No settlement is made without your specific direction. We tell each client about any settlement offers we get, and we ask each client what they want to do. If we feel that a settlement can be made which is in your best interest, we will make such a recommendation to you.

Now we want you to give us the answers to some questions.

POTENTIAL CLIENT INFORMATION - SHORT FORM

What is your full name?_______________________________ Social Security #:______________

Present Address?________________________________________________________________

Present Home Phone?

If Different from above--what is your usual home address and phone?

Work Phone?_____________________________ Any Fax number we can send things to you?

What is the best phone or way to contact you during the work day?________________________

Your employer?_______________________ Your job?__________________________________

Spouse's name?_______________________ Spouse's work phone?________________________

Spouse's employer?___________________ Spouse's job?________________________________

What is your date of birth?_____________ Spouse's birth date?____________________________

How did you hear about our firm?

_____Another attorney recommended ( )

_____Friend recommended

_____Other.( )

GENERAL NATURE OF THE MATTER

General Facts About the Matter:

1. Date:_______________ Day of the Week: _______________ 

Time:__________________

2. Location:

3. Describe generally what happened:

Facts Concerning the Defendant:

1. Name and address of party you think is responsible:

2. Why do you think that party is responsible? What did they do wrong?

What Documents Do You Have About the Matter?

Any. Letters?

Any Contracts?

Any Notes?

Any Photographs?

1. If any representative from the defendant, or an insurance adjuster or attorney has seen you for the other side, write his name, address and phone number here.

2. Did you give a written or tape recorded statement to that person?__________________.

BECAUSE OF WHAT THE DEFENDANT DID:

WHAT EXPENSES OR DAMAGES HAVE YOU HAD?

1.

2.

3.

WHO CAN BE A WITNESS TO HELP YOU ESTABLISH THE FACTS ABOUT WHAT THE MATTER OR ABOUT WHAT DAMAGES YOU HAVE HAD?

1.

2.

3.