Personal Injury & Accident Claim Intake — Kickoff intake form (public) for Legal. Embeddable version — a transparent, chrome-free form that floats over your own website design (pair with the standalone version for a hosted page).

A confidential intake for accident and injury claims so we can evaluate your case quickly and protect your rights. Submitting this does not create an attorney–client relationship.

What it collects (by section):

• About you — First name [short text]; Last name [short text]; Email address [short text]; Client Role in Matter [dropdown: Individual / Business / Plaintiff/Claimant / Defendant/Respondent / Petitioner / …]; Matter Type (legal) [dropdown: Consultation / Contract/Transaction / Dispute/Negotiation / Litigation / Family / …].
• The incident — Facts Summary (legal) [long text]; Desired Outcome (client-stated) [long text]; Amount in Controversy (est.) [number].
• Other parties & insurance — Adverse Party Name(s) [long text]; Insurance Involved (claim) [dropdown: None / Client's insurer / Opposing insurer / Both / Unknown]; Insurer Name(s) [long text]; Claim Number(s) (if any) [short text]. Who else was involved and any insurance — names only, never policy or account numbers.
• Evidence & witnesses — Evidence Sources (initial) [multi-select: Documents / Photos/Video / Emails/Text messages / Social media / Contracts / …]; Witness List (initial) [long text].
• Working together — ADR Preference [dropdown: Mediation / Arbitration / Negotiation / Litigation only / Open to any]; Privilege / Confidentiality Channel [dropdown: Client portal / Encrypted email / Phone / In-person / Mixed].

Required: Email address, Client Role in Matter, Facts Summary (legal) (kept low-friction).

Form type: Kickoff intake (in), public. Niche: Legal. Deployment: embed.

Best for / surface when: Legal client workflow — personal injury & accident claim intake.