OWCP Case Intake

Konexo OWCP Case Intake

This intake form collects information regarding a federal workers' compensation case. Please provide accurate facts, dates, and documents whenever possible. If you do not know an exact answer, provide your best estimate. This form is for case evaluation and preparation purposes only and does not constitute legal advice.
CLIENT CONTACT INFORMATION
Purpose of this intake: This form helps Konexo OWCP Case Intake gather key information about your situation so a consultant can review your case before your consultation. Please provide accurate facts and dates to the best of your ability. You may upload supporting documents such as medical records, agency letters, forms, employer notices, and correspondence. Submitting this intake does not create an attorney-client relationship and does not constitute legal advice. A Konexo consultant will review your information and follow up with you about next steps.
CLIENT CONTACT INFORMATION
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

CURRENT PROBLEM
List treatments received such as: Physical therapy, Surgery, Medication, Injections, Other
WORK STATUS AND LIGHT DUTY
Current work status

Konexo OWCP Case Intake