Free printable car accident worksheet

Car Accident Intake Form for Law Firms: Questions & Workflow

Use one practical workflow for car-crash and broader motor-vehicle accident (MVA) intake: collect collision facts, injuries, treatment, insurance activity, evidence, and next-step ownership without making fault, deadline, claim-value, or representation decisions.

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Published by ClaimVela · Updated October 19, 2026 · This operational resource is not legal advice, medical advice, or a universal form. Have authorized counsel adapt every question, notice, consent, conflict control, escalation rule, and communication step to the firm's jurisdictions and procedures.

Stage 1 · First contact

Open a reliable motor vehicle intake record

These groups cover the minimum useful opening record. Gather names and organizations early for the firm's duplicate and conflict process. Use approved language, avoid detailed document collection, and branch only when a response makes another question relevant.

Inquiry control and safe contact

Create one accountable record and a permitted way for the firm to respond.

Inquiry ID, received date and time, source, channel, and campaign
Caller name, injured person's name, and their relationship if different
Phone, email, preferred method, safe contact times, and message restrictions
Inquiry-contact permission and the notice version, timestamp, and action
Optional marketing consent kept separate from required intake contact
Preferred language, accessibility needs, and local time zone
Assigned owner, first-response target, and escalation owner — internal

People and vehicles

Identify the known participants and organizations needed for duplicate checks and the firm's conflict process.

Drivers, passengers, pedestrians, cyclists, and registered vehicle owners
Vehicle year, make, model, color, plate, and state when known
Employers, rideshare platforms, delivery companies, vehicle lessors, or government entities reportedly involved
Known witnesses and contact information
Name variations and reported roles for each person or organization

Collision snapshot

After opening controls, record a brief account of when, where, and how the event occurred without deciding fault.

Collision date and approximate time, with unknown or estimated details labeled
Street, intersection, city, state, roadway, parking area, or other location
Short description in the caller's own words
Vehicle, pedestrian, bicycle, motorcycle, rideshare, commercial, or other reported context
Whether another collision or event occurred in the same sequence

Injuries and immediate care

Capture reported symptoms and care so authorized staff can identify the next review step.

Reported injuries, symptoms, affected body areas, and when symptoms began
Emergency response, transport, hospital, urgent care, or other treatment
Current safety or medical concern and whether care is underway
Upcoming appointments or recommended follow-up reported by the caller
Work, school, caregiving, mobility, or daily-activity impact reported so far

Reports and insurance activity

Inventory records and communications without advising the caller what to say, sign, accept, or reject.

Police, crash, incident, or exchange report and the issuing organization
Report number, responding agency, and officer name when known
Known insurers, policyholders, claim numbers, adjusters, and contact details
Whether statements, authorizations, releases, payments, offers, denials, or other documents exist; defer detailed collection until the firm's approved gate
Current or prior attorney contact or representation concerning the collision

Evidence and next action

Identify what exists, where it is, and who owns the next step before the call ends.

Scene, vehicle, injury, roadway, signal, or property photographs and video
Dashcam, surveillance, telematics, phone, vehicle, or electronic sources reportedly available
Vehicle location, repair status, physical items, and possible loss or overwrite risk
Whether files or physical items exist; defer a secure collection request until the firm's conflict and authorization gate is complete
Next action, owner, due date and time, time zone, and approved channel

Firm-defined prompt review

Route signals; do not make conclusions

Train staff on the firm's authorized response before these facts appear. A signal should change routing or priority—not produce a liability, deadline, value, or case-acceptance answer.

Immediate danger, emergency medical need, or a serious safety concern

Pause ordinary intake and use the firm's approved emergency or safety procedure. The intake form is not an emergency service.

A court, agency, insurer, or other document states a response date

Preserve the exact document and stated date, then route it promptly to an authorized attorney. Do not calculate a deadline.

A vehicle, video, electronic record, roadway condition, or other possible evidence may change or disappear

Record what reportedly exists, where it is, and who controls it, then escalate under firm policy without improvising legal instructions.

A minor, death, incapacity, government entity, commercial vehicle, rideshare, or firm-defined urgent circumstance is involved

Send the known facts to the firm's authorized review owner. Treat the category as a routing input, not a liability conclusion.

The person has current or prior counsel or may have signed a representation agreement

Record the person's words and available documents, then request authorized review. Do not advise the person to end another relationship.

A duplicate, related inquiry, involved party, or other possible conflict input appears

Pause ordinary qualification, limit access under firm policy, and use the firm's conflict process. Intake staff do not clear conflicts.

Stage 2 · Focused follow-up

Build a review-ready collision record

Ask these questions only after the firm's conflict process and an authorized reviewer determine that the information is reasonably necessary. Keep direct observations, reported accounts, and documentary information distinct so the reviewer can see what is known and what still needs work.

Scene and sequence

Direction and lane of travel reported for each participant
Traffic control, intersection, roadway, construction, weather, visibility, and lighting facts
Reported actions immediately before, during, and after the collision
Points of impact, final positions, secondary impacts, and property affected
Source of every detail: caller observation, another person's statement, report, photo, or unknown

Occupants and safety systems

Seating position and reported role of every occupant
Seat belt, child-restraint, helmet, airbag, or other reported safety-system facts
Whether anyone left the scene, was transported, or later sought care
Known vehicle ownership, use, permission, employment, rental, or rideshare context
Names and contact details still missing

Injuries, treatment, and history

Reported symptom onset, body areas, progression, and current condition
Emergency response, facilities, providers, diagnostics, prescriptions, and visit dates
Recommended care, scheduled appointments, barriers, and reported treatment gaps
Relevant prior symptoms, injuries, treatment, or incidents only when an authorized reviewer determines they are reasonably necessary
Records or authorizations requested only through the firm's approved process after the collection gate

Insurance and communications

Reported liability, collision, medical-payment, PIP, UM/UIM, health, or other coverage information
Carrier, policyholder, claim number, adjuster, and contact information
Recorded or written statements and the date, recipient, and available copy
Forms, authorizations, releases, estimates, denials, payments, or offers received
Repair shop, rental, towing, storage, lienholder, or other service-provider contacts

Evidence and document inventory

Police or incident report, driver exchange, citation, diagram, and dispatch information
Relevant photos, video, dashcam, surveillance, messages, call logs, or social posts only when an authorized reviewer determines they are reasonably necessary
Witness details and reported observations
Vehicle location, repair or total-loss status, estimates, receipts, and damage records
Custodian, current location, access path, collection status, and possible loss risk for each item

Impact and attorney-review handoff

Reported work, school, caregiving, household, travel, sleep, and daily-activity impact
Known expenses, wage information, property loss, benefits, liens, and practical barriers only when reasonably necessary for authorized review
Confirmed, reported, disputed, unknown, and missing information kept separate
Focused questions and documents requiring authorized review
Review owner, priority, next action, due time, and approved communication path

Copyable printable template

Car Accident Intake Form — Operational Worksheet

Print this worksheet or translate its sections into the firm's reviewed intake system. Complete detailed sections only after the firm's conflict process and an authorized reviewer determine what is reasonably necessary. Add jurisdiction-specific controls only after authorized legal and operational review.

A. Intake control — internal

Inquiry ID:

Received date, time, and time zone:

Source, channel, campaign, or referral:

Assigned owner:

Response target and escalation owner:

Duplicate and conflict-review status:

Acknowledgement delivery result:

Notice and consent version, timestamp, and recorded action:

B. Caller and safe contact

Caller name and preferred name:

Injured person and caller relationship, if different:

Phone and email:

Approved contact method, times, and message restrictions:

Inquiry-contact permission by channel:

Separate optional-marketing consent, if offered:

Preferred language and accessibility needs:

Current or prior attorney involvement:

C. Collision overview

Date and approximate time:

Exact or best-known location:

Collision type or context:

Caller account in their own words:

Reported sequence and other involved events:

Police or incident report and number:

D. People, vehicles, and organizations

Drivers, passengers, pedestrians, cyclists, and witnesses:

Vehicle owners and identifying details:

Employers, platforms, lessors, carriers, or government entities:

Reported role and source for each name:

Missing names or contact details:

E. Injuries, care, and impact — after approved gate

Reported injuries, symptoms, onset, and body areas:

Emergency response and transportation:

Facilities, providers, visit dates, and diagnostics:

Recommended or scheduled follow-up:

Relevant prior conditions or related incidents only when authorized and reasonably necessary:

Work, school, caregiving, and daily-activity impact:

F. Insurance, evidence, and communications — after approved gate

Carriers, coverage reported, policyholders, claims, and adjusters:

Statements, forms, releases, payments, offers, or denials:

Report, exchange, citation, photos, video, dashcam, and surveillance:

Vehicle location, repair status, estimates, and physical items:

Evidence custodian, collection status, and possible loss risk:

G. Review and next action — internal

Confirmed facts:

Reported or disputed facts:

Unknown and missing information:

Prompt-review signal and escalation result:

Authorized reviewer:

Next action, owner, due date and time:

Disposition and communication delivery result:

Accuracy labels

Make the status of every important fact visible

Confirmed

Supported by a record the firm has reviewed or directly verified through an approved process.

Reported

Provided by the caller or another identified source but not independently verified.

Disputed

Accounts or documents differ; preserve each version and its source without resolving the issue in intake.

Unknown

The person does not know or the information is unavailable; never replace it with an assumption.

Missing

The field remains unanswered and needs an assigned follow-up question, owner, and target.

Intake guardrails

Keep operational fact capture separate from legal judgment

Do not decide who caused the collision or label a person, vehicle, or organization legally responsible.
Do not calculate a filing, notice, insurance, or other deadline from intake facts.
Do not estimate case value, damages, settlement range, acceptance likelihood, or outcome.
Do not diagnose an injury, attribute medical causation, or recommend treatment.
Do not advise the person what to say, sign, post, preserve, repair, accept, reject, or do unless using authorized attorney language.
Do not state or imply that the firm represents the person before the firm's authorized engagement process is complete.
Do not treat a completed form as conflict clearance or case acceptance.

Mobile form design

Let the person finish the opening form

Use a single-column layout, visible labels, short groups, clear unknown options, and the appropriate mobile keyboard. Preserve answers after validation errors. Let the person defer uploads and save detailed follow-up rather than blocking the initial inquiry on a slow connection.

Privacy and communication

Minimize first; protect what follows

Explain why sensitive information is requested, separate inquiry contact from optional marketing permission, and record the notice version and consent action. Use secure transmission, private storage, role-based access, revocable collection links, retention rules, and delivery-failure visibility. Avoid placing sensitive narratives or attachments in routine notification email.

Primary sources for policy design

Adapt the workflow through authorized review

Prospective-client duties

The ABA Model Rule 1.18 commentary discusses when communications may become a consultation and limiting an initial consultation to information reasonably necessary for the representation decision. Apply the firm's jurisdiction-specific rules and counsel-approved procedures.

Confidentiality and access

ABA Model Rule 1.6 addresses confidentiality of information relating to client representation and reasonable efforts against inadvertent or unauthorized disclosure or access. For prospective-client information, review Rule 1.18 and its Rule 1.9 cross-reference, together with applicable local rules and firm counsel, when designing access, notification, storage, and vendor controls.

Data minimization

The FTC's general business guidance, Start with Security, recommends not collecting personal information a business does not need, retaining it only for a legitimate need, and limiting access. It is useful design guidance—not a substitute for a law firm's legal, ethical, and security review.

Consistent crash vocabulary

NHTSA describes the Model Minimum Uniform Crash Criteria (MMUCC) as a voluntary, standardized set of variables for describing motor-vehicle traffic crashes in state and law-enforcement reporting. A firm may consult its terminology as an operational taxonomy, but MMUCC is not a required law-firm intake form and does not replace a police report, state requirements, or legal judgment.

This resource does not supply jurisdiction-specific deadlines, preservation instructions, consent language, conflict clearance, liability analysis, claim valuation, or case-acceptance criteria.

Frequently asked questions

Building a reliable car accident intake form

What should a car accident intake form collect first?

Start with safe contact information, the people and organizations needed for opening controls, collision date and location, a short account in the person's own words, a reported injury and care snapshot, whether reports or evidence exist, and an assigned next action. Detailed follow-up should wait until the firm's conflict process and an authorized reviewer determine what is reasonably necessary.

Should an MVA intake form ask who was at fault?

The form should collect observable facts and each source's account without turning an intake response into a liability decision. Attorneys or other authorized reviewers remain responsible for legal analysis.

How should unknown collision details be recorded?

Use an explicit unknown option instead of forcing an estimate. Keep confirmed, reported, disputed, unknown, and missing information separate, then assign focused follow-up for details the firm needs.

What evidence details belong in motor vehicle intake?

First record what reportedly exists, who controls it, where it is, and whether it may change or disappear. After the firm's approved conflict and authorization gate, collect only the reasonably necessary reports, photos, video, dashcam, surveillance, messages, witness details, vehicle records, physical items, or electronic sources through the approved secure process.

Does submitting a collision intake form create representation?

A form should not promise or imply representation. Use firm-approved, jurisdiction-appropriate notices and keep the matter labeled as prospective-client work until the firm's authorized engagement requirements are complete.

How can a firm make a car accident intake form easier to complete on a phone?

Use a single-column flow, short question groups, visible labels, appropriate mobile keyboards, clear unknown options, save-and-resume for follow-up, and optional later uploads rather than blocking the first submission.

Turn the form into accountable intake

Keep collision facts, follow-up, evidence, review, and handoff in one workflow.

ClaimVela helps PI firms receive inquiries, assign ownership, collect structured facts and documents, prepare attorney review, communicate securely, and carry retained matters forward without rebuilding the record. Attorneys remain responsible for conflicts, legal judgment, deadlines, qualification, and every representation decision.

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