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INSURANCE INTAKE FORM Bhhamdbbcomb

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welcome to massives how to fill out client intake form and authorizations which are the forms needed to submit a case our client intake form is a one-page fillable PDF that you can type right on to in lieu of using our secure portal submission please fill this out completely as it includes everything the lien holders will require to resolve the lien beginning on the upper left we ask for the plaintiff's personal information such as address and date of birth if there is a guardian administrator or conservator please list their name next we have your law firm information section please list all attorneys and paralegals that should receive lien updates on the right you see an injury information section including date event such as rear-end collision or nursing home fall and injuries sustained from the event please include any pre-existing conditions as they help us dispute unrelated items last date of treatment is also a key field if your client is still treating please indicate t

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