AutoIntake
Admin Tester
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Intake Packet
Caller Number
Caller Name
Callback Phone
Email
Preferred Language
Incident Date
Incident Location
Incident Type
Incident Summary
Rear-ended while stopped at a red light. Other driver exchanged insurance information.
Injuries
Neck and back pain, went to urgent care the next morning.
Medical Treatment
Urgent care visit, follow-up recommended if pain continues.
Witnesses / Evidence
No witnesses captured yet; caller may have photos of vehicle damage.
Police / Incident Report
No police report yet.
Insurance
Other driver's insurer called, caller has not signed anything.
Employment / Financial Impact
Missed one shift and is worried about transportation.
Prior Attorney
Urgent Reason
Recommended Next Step
Attorney review and callback tomorrow morning.
Consent captured
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