Universal Intake Form

Universal Intake Form

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We believe every step of the litigation lifespan should be streamlined to reduce liability and costs, while increasing profits. Our team is ready to assist you and your firm with your biggest challenges.

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Attorney Information
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Law Firm Information
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Beneficiary Information
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Beneficiary Contact Information
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Case Information

Services Requested
Affidavit Certification & Medical Expert Selection Additional Information
Nurse Consulting Services Additional Information
Fee Applies
Standard Turnaround. Fee Applies.
Lien Resolution Additional Information
Is the beneficiary expected to receive or currently receiving any of the following public benefits? 
Medical Record Retrieval Additional Information
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MSA Additional Information

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