Legal · free template

Personal Injury Intake

Three-page personal injury enquiry: how the accident happened, injuries and treatment, time off work and costs, insurers and any deadline pressure.

A ready-to-use legal & professional services form for law firms and in-house legal teams: 28 questions, 3 pages, 4 conditional rules.

Questions: 28
Pages: 3
Layouts: classic · card
Time to complete: ≈ 10 min
Conditional rules: 4

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Live preview and test console

This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 3 — The accident

Every question on this page is currently visible.

Compliance checklist

Ready to publish

Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
Legal text not required — passingThis template collects neither health nor regulated financial information.
Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Personal Injury Intake is built for law firms and in-house legal teams who need to intake a matter with the facts, parties and consent recorded.

Law firms and in-house legal teams working in legal & professional services.
Teams who need to intake a matter with the facts, parties and consent recorded without writing code or paying for a custom build.
Anyone replacing conflict checks delayed by missing intake detail with one structured record per enquiry.
Respondents are clients and claimants — the form asks them 28 questions across 3 screens.
Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of conflict checks delayed by missing intake detail and turns each submission into a record your team can act on immediately.

16 questions are required, so submissions arrive complete instead of needing a follow-up email.
It collects a verified email address so replies and confirmations land.
It captures a phone number for urgent follow-up.
It accepts a document or photo upload as evidence.
It pins the request to a specific date.
It allows multiple selections without free text.
Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1Press “Use this template” — a fresh copy of Personal Injury Intake lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4Check the upload limits on the file question so respondents can attach what you actually need.
5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

Features conditional validation: if “Did anyone see the accident?” is Yes, “Witness names and how to contact them” becomes mandatory before the form can be sent.
Features conditional validation: if “Have you had time off work?” is Yes, “How much time off, and what do you earn?” becomes mandatory before the form can be sent.
Features advanced show logic: if “Have you already spoken to another firm about this?” is Yes, the form dynamically exposes “Which firm, and what stage did it reach?”. Otherwise that question never appears.
Features conditional validation: if “Have you been given any deadline or court date?” is Yes, “What date were you given?” becomes mandatory before the form can be sent.
All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

Personal injury enquiries arrive in fragments — a phone call, a follow-up email, a photo sent days later — and the case handler ends up assembling the story from three places. This three-page intake collects it in one, in the order a file is built. The first page covers the incident: date, time and place, what type of accident it was, what happened in the client's own words, who else was involved, whether police or an employer were told, and whether anyone saw it. The second page covers the injuries and their treatment: what was hurt, where the client was seen, what has happened since, and what they still cannot do. The third page covers consequences and paperwork — earnings lost, expenses paid out, insurers and reference numbers, other firms already contacted, and any date the client has been given. Time limits for bringing a claim vary by jurisdiction and by the kind of accident, so the form asks about dates and deadlines rather than telling anyone what theirs is. No answer here is an assessment of whether a claim will succeed.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — The accident

Your full namerequired
Best contact numberrequired
Email addressrequired
Date of the accidentrequired
Roughly what time?
Where did it happen?required
What kind of accident was it?required
Describe what happened in your own wordsrequired
Who else was involved?
Was it reported to anyone?required
Did anyone see the accident?required
Witness names and how to contact them

Page 2 — Injuries and treatment

What were you injured?required
Were you seen by anyone at the time?required
What treatment have you had since?
Are you still having treatment?required
What can you still not do that you could before?
Upload photos, letters or discharge papers

Page 3 — Costs and paperwork

Have you had time off work?required
How much time off, and what do you earn?
What have you had to pay out because of the accident?
Your insurer and policy number, if relevant
The other side's insurer and any reference number
Have you already spoken to another firm about this?required
Which firm, and what stage did it reach?
Have you been given any deadline or court date?required
What date were you given?
Confirmationsrequired

28 questions in total.

Example of a completed personal injury intake form

This sample enquiry shows how a claimant's account is captured across the accident, injuries and costs.

Your full name: Karen Whitlock
Date of the accident: 3 February 2026
Where did it happen?: Car park outside Fenwick Street Supermarket
What kind of accident was it?: Slip, trip or fall in a public place
Describe what happened in your own words: I stepped in an unmarked puddle near the trolley bay and fell onto my left side.
Did anyone see the accident?: Yes
What were you injured?: Sprained wrist and bruising to the hip
Have you had time off work?: Yes
Have you already spoken to another firm about this?: No

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Did anyone see the accident?”

Makes answers required
If “Did anyone see the accident?” is Yes, “Witness names and how to contact them” becomes required before the form can be submitted.

Driven by “Have you had time off work?”

Makes answers required
If “Have you had time off work?” is Yes, “How much time off, and what do you earn?” becomes required before the form can be submitted.

Driven by “Have you already spoken to another firm about this?”

Reveals questions
If “Have you already spoken to another firm about this?” is Yes, the form reveals “Which firm, and what stage did it reach?”.

Driven by “Have you been given any deadline or court date?”

Makes answers required
If “Have you been given any deadline or court date?” is Yes, “What date were you given?” becomes required before the form can be submitted.

Set it up step by step

1
Put the deadline question where it is seen
Keep it on the final page but route any submission with a date straight to a named person, because that is the answer that changes today's workload.
2
Let the client write the account
The free-text description is more useful than a list of tick boxes; a handler can structure it later, but nobody can recover detail the form never asked for.
3
Ask for the photos early
Uploads shrink as weeks pass, so the injuries page collects them while the client still has them on their phone.
4
Screen without judging
The other-firm question exists to spot a conflict, not to filter people out, so keep the wording neutral.

Mistakes to avoid

Stating a time limit in the form's help text, when limits differ by jurisdiction and by accident type.
Suggesting a likely value or outcome anywhere on the page, which sets an expectation nobody can stand behind.
Collapsing injuries and treatment into a single box, so the record loses what was hurt and what was done about it.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Send new enquiries to the intake queue, flag any deadline answer immediately, and use the witness details to send the Witness Statement Form while memories are fresh.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the personal injury intake, matched on the words people actually search for.

Privacy & compliance

This form collects identity or financial details. Enable encrypted answers on the sensitive fields, avoid emailing full values in notifications, and delete responses once the check is complete.

Frequently asked questions

Does completing this start a claim?

No. It is an enquiry so the firm can decide whether it can help. Any claim starts later, after a conversation and the firm's own checks.

How is this different from the insurance claim forms?

The Auto Insurance Claim reports an incident to an insurer under a policy. This form gathers the facts a law firm needs to assess a claimant's enquiry.

Will the form say whether the claim is in time?

No. It asks about dates and any deadline the client has been given, because limits vary by jurisdiction and only a lawyer should read them against the facts.

What if the client does not know the other insurer?

That field is optional. A handler can often trace it from the vehicle or property details captured on the first page.

Is the Personal Injury Intake template free to use?

Yes. You can preview and test Personal Injury Intake on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Personal Injury Intake template ask for?

It asks 28 questions across 3 pages, 16 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Personal Injury Intake form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this legal & professional services form work?

4 conditional rules ship with the template: Features conditional validation: if “Did anyone see the accident?” is Yes, “Witness names and how to contact them” becomes mandatory before the form can be sent. Features conditional validation: if “Have you had time off work?” is Yes, “How much time off, and what do you earn?” becomes mandatory before the form can be sent. Features advanced show logic: if “Have you already spoken to another firm about this?” is Yes, the form dynamically exposes “Which firm, and what stage did it reach?”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Personal Injury Intake form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Personal Injury Intake form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Can respondents upload files?

Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.

More forms teams pair with the personal injury intake.

Related categories

All Legal & Professional Services templates

Personal Injury Intake

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