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CLIENT CONTACT FORM
Date: ____________ Time: __________ Firm ____________________________________________________________ Attorney Name: ____________________________ Tel No (____)_____________ Email: _______________________ Fax No. (____)________________________ Address: ________________________ City: _ __________State: ___ Zip: _____ Date of Agreement: _________ Referred By:______________________________ Secretary Name: ______________________ Paralegal Name: ________________ Additional Information re: Attorney or Firm: _________________________________________________________________ _________________________________________________________________ Plaintiff: _____ Defense: _____ Attorney Specialties: _____________________ _________________________________________________________________
Type of Case: Personal Injury ____ Medical Malpractice ____ Product Liability ____ Other ____
Date Filed: ________ Discovery Ends: __________ Court: _________________
Requested: Dates of Completion or Report Sent ______ Organize Records ____________________________ ______ Review for Merit ____________________________ ______ Paginate ____________________________ ______ Bind Records ____________________________ ______ Summarize ____________________________ ______ Narrative ____________________________ ______ Deposition Questions ____________________________ ______ Standards of Care ____________________________ ______ Identify Expert ______ Locate Expert ______ Contact Expert ______ Research Expert’s Credentials and Publications __________________ ______ Literature Search ______________________ ______ __________________________ ____________________ ______ __________________________ ____________________ ______ __________________________ ____________________ ______ __________________________ ____________________
Medical Records Tracking
PLAINTIFF
Opposing Attorney: ___________________________________________________________
Firm: _______________________________________________________________________
Phone No.: __________________________________________________________________
Conflict of Interest Concern? Yes __________ No_____________
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