PARRIS LAW FIRM
NEW CLIENT CALL OVERFLOW INTAKE SHEET
Please state to caller: “UNTIL A REPRESENTATION AGREEMENT HAS BEEN SIGNED WE CANNOT GIVE YOU LEGAL ADVICE NOR ARE WE YOUR ATTORNEYS”
Was this Completed?
Conflict Check Done?
Yes
No
Walk up?
Please Select
YES
NO
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
How did you hear about us?
Referral Source:
What type of Case are you calling about?
Primary Language:
English
Spanish
Bi-Lingual:
Please Select
YES
NO
PARRIS Employee Name:
Please Select
Mike Miscione
Yesenia Clark
Daniel S. Throckmorton
Doug Sweeney
Barbara Batugo
Breanna Parris
Sara Bejarano
Receptionist
Valeria Rodriguez
Richard Miler
PARRIS Employee Name:
First Name
Last Name
PARRIS Employee Email:
example@example.com
PARRIS Employee Email:
Please Select
mcmiscione@parris.com
yclark@parris.com
dthrockmorton@parris.com
dsweeney@parris.com
bbatugo@parris.com
Breanna@parris.com
sbejarano@parris.com
mmarquez@parris.com
mary@parris.com
amartin@parris.com
rmiler@parris.com
Client Name:
Prefix
First Name
Last Name
Main Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Alt Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Client Email:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Area of Law:
Please Select
General Litigation
Personal Injury
Employment
Area of Law:
Date and Time of Incident:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident:
Description of Incident:
Injuries:
IF FATALITY, FRACTURE, HEAD INJURY, HOSPITALIZED OR MAJOR INJURIES, YOU MUST GET AN INTAKE REP TO TAKE OVER THE CALL OR SET AN APPT. IF INTAKE REP IS UNAVALABLE SEEK MANAGEMENT ASSISTANCE
Report Taken?
Please Select
CHP
Sheriff
Other
NO
Other Agency:
Report ID:
Vehicle Damage:
Make and Model of Vehicle:
Drivable:
Please Select
YES
NO
Towed to where if known:
Insurance (DO NOT obtain insurance if a conflict check has not been requested and completed by Intake.):
Rows
Company
Policy Number
Claim Number if made
Plaintiff
Defendant if known
-Action Taken-
*If all Intake Reps are unavailable, set a same day appointment for 10:00 AM, 1:00 PM or 4:00 PM for cases involving, fatality, fracture, head injury, hospitalized or major injuries. Do not take a message for a return call. Set the appointment while on the phone with the potential client. Ask potential clients to have the following readily available: Any information they have concerning the accident, police report, photographs, vehicles involved in collision, insurance policies, info on the other party, etc. The Intake Department will contact them to confirm the appointment.
Date and Time of Appointment:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Referral Given:
Referral Given:
Please Select
YES
NO
Rows
Name
Area of Law
Attorney Referred:
Area of Law:
Told client attorney referred to would call them:
Please Select
YES
NO
Faxed to Referral Attorney:
Letters to be done:
Rows
Checkbox
Thank you - Call Referral
Thank you - Call No Referral
Appointment Reschedule
Rows
Entered On
By
Computer:
Submit
Should be Empty: