It was a pleasure speaking with you today and we look forward to representing you.
Below please find the link to our Case Intake Form. Please fill out the information to the best of your knowledge and call us if you have any questions.
Case Intake Form.
In addition, please read and sign the following documents:
Employee Verification of Lost Wages: is the form that you keep and you fill out the days that you miss from work and have your employee sign and verify it. The days that you miss from work has to be reasonable and necessary with the doctor’s permission. You can turn this form to me when you are done with treatment. (Please make sure you keep track of the exact dates and the number of hours you miss from work.)
Employee Verification of Lost Wages
HIPAA Medical Authorization: gives us permission to access your medical records. (Please only sign and date this page, we will fill out the rest).
HIPAA Medical Authorization
Vehicle Damage Election: give us permission to handle your vehicle damage for you.
Vehicle Damage Election
Special Power of Attorney: gives us permission only as to your Personal Injury case to sign and authorize documents as necessary.
Special Power of Attorney
The Contingency Contract: is the contract between you and the firm and it states our fees. Please read and understand the contract and if you have any questions feel free to contact us and we will further explain.
The Contingency Contract