Initial Client Interview Form

A. CLIENT PERSONAL INFORMATION

Name: Justin King

Address: 123 Main Street, Kansas City, Missouri

Home Phone: (913)123-4567 Work Phone: (913)890-1234

Social Security Number: 123-45-6789

Driver’s License Number: MO39562243

Date of Birth: 7/14/83

Marital Status: Single Dependents: None

Military Status: N/A

Occupation: Student/Retail

Employer Name, Address, Phone Number:
__________________________________________________________

Membership in Union or Professional Organization: N/A

Police Record (if any): N/A

Have you ever filed bankruptcy? If so, please explain. N/A

B. CLIENT EMPLOYMENT

Type of Work: Retail Sales Job Title: Cashier

Immediate Supervisor’s Name:
Did the accident take place during the day time or at night? Was Mr. King drinking at his agents home? Were there any other vehicles on the road at the time of the accident? Was Mr. King wearing a helmet? Does he have copies of his bills? Does he have a copy of his cancelled contract? Does he have any income since his initial accident? Has he ever sued anyone before?

G. ADDITIONAL RESEARCH/INVESTIGATION NEEDED/DISCOVERED:

Check to see if there are any video surveillance cameras (used for speeders) anywhere along Interstate 57. If there is then we should view them to see if any of them picked up Mr. King and the Beer Truck right before, during and directly after the accident. Track down and talk to the Police Officers on the scene. Track down and talk to the Ambulance attendants on the scene to find out Mr. Kings condition at the scene of the accident. And try to locate and talk to the driver of the beer truck. Get a copy of the police report and the Doctors reports from both hospitals.

All Insurance Information is yet to be determined

H. INSURANCE INFORMATION.

Client Carrier:

Address and Phone Number

Policy Number

Opposing Parties:

Carrier #1:

Address and Phone Number

Policy Number

Carrier #2:

Address and Phone Number

Policy Number

Thanks David---for this assignment you were to complete the initial interview and investigation sheet, and include a brief explanation why each piece of evidence is