Abacus Law Client In-Take Sheet Sample
Law Area: Medical/Legal Malpractice

AC Consulting Legal Office Technology & Automation









LAW OFFICE INFORMATION SHEET

Current Date: ____________________

1.
NEW MATTER INFORMATION

Matter Name: __________________________________________________
File No.:______________________________________________________
Case Code: ____________________________________________________
Attorney: _____________________________________________________
Carrier: ______________________________________________________
Representative: _______________________________________________
Carrier No.: __________________________________________________

Opened Date: __________________________________________________
Closed Date: __________________________________________________

2.
COURT INFORMATION

Court: _______________________________________________________
Court No.: ___________________________________________________
Date Filed: __________________________________________________

3. OUR CLIENT

Last Name: ____________________________________________________
First Name: ___________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Home Phone: (_____)____________________________________________
Fax: (_____)___________________________________________________
Pager/Cell: (_____)____________________________________________
Office Contact: _______________________________________________

4.
CAPTION

Plaintiff: ____________________________________________________
Defendant: ____________________________________________________

5.
PLAINTIFF ATTORNEY INFORMATION

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Fax Phone: (_____)_____________________________________________

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Fax Phone: (_____)_____________________________________________

6.
DEFENSE ATTORNEY INFORMATION

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Fax Phone: (_____)_____________________________________________

Gender (m/f): __________________
Last Name: ____________________________________________________

First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________

City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________

Fax Phone: (_____)_____________________________________________



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