Personal Injury Intake | SLC Legal, Inc.

Take it Back. Start with the incident.

This intake is designed to capture the facts that matter most at the outset: where the incident happened, what type of case it is, what mechanism caused injury, what treatment followed, and what insurance or coverage may apply.

California and Hawai'i cases share many core questions, but Hawai'i auto cases need early no-fault and PIP screening. That is built into this intake.

What matters early

Clear incident facts and chronology
Clear liability and notice details
Clear injury, treatment, and coverage information

What clients do not need

Perfect medical terminology
Exact insurance information before starting
Every record before submitting the intake

Contact information

This is the only section that must be completed in full so we can follow up.

Start by selecting the state that applies to the incident so the intake can branch correctly from the outset.

State

Required

California Hawai'i

Full nameRequired

PhoneRequired

EmailRequired

City / county

Preferred contact method

Phone Email Text

Best time to reach you

Preferred language

Case Type

Select the case type that best fits the incident.

Use the closest fit if you are not sure. The intake will open the questions that matter most for that type of case.

Case type

Required

Auto collision Pedestrian or bicycle collision Slip and fall or dangerous condition Other personal injury

If other, briefly describe the case type.

Incident

Identify where, when, and how the incident happened.

Chronology and location matter. Best estimates are okay.

Incident date

Approximate time

Incident location

County / island

In a few sentences, how did the incident happen?

Collision details

These questions help identify mechanism, fault, witnesses, and available coverage.

Your role

Driver Passenger Pedestrian Bicyclist Motorcyclist Other

Type of collision

✓Rear-end ✓Intersection ✓Lane change or sideswipe ✓Left turn ✓Parked vehicle ✓Hit and run

Vehicles involved

Point of impact

Police or responding agency

Report number

Dangerous condition details

These questions help identify the condition, notice, photographs, and who controlled the property.

Type of condition

✓Wet or slippery floor ✓Uneven surface or broken pavement ✓Poor lighting ✓Stairs or handrail issue ✓Object in walkway ✓Other dangerous condition

Property type

Property owner or business

How long had the condition been there?

Liability

Capture the facts that point to fault, notice, and potential defenses.

This section is built to surface comparative-fault, notice, and property-control issues early.

Auto liability and fault

What do you think caused the collision?

✓Speeding ✓Failure to yield ✓Distracted driving ✓Unsafe lane change ✓Following too closely ✓Traffic signal or stop sign violation

Did the other driver receive a citation?

Yes No Not sure

Other driver / owner information

Witnesses

Premises liability and notice

Was the condition reported to anyone?

Yes No Not sure

Were there warning signs or cones?

Yes No Not sure

Who was it reported to?

Why do you think the property owner or business should have known?

Anything that may be used to blame you?

✓Distracted or looking away ✓Using phone ✓Footwear or carrying items ✓Speed or following distance ✓Alcohol or medication issue ✓None known

Injuries

Identify body parts, immediate symptoms, and what changed after the incident.

Use plain language. Medical terminology is not required.

Body areas injured

✓Head or face ✓Neck ✓Back ✓Shoulder or arm ✓Hip or leg ✓Knee or ankle ✓Hand or wrist ✓Internal injury ✓Other

Immediate symptoms

Current symptoms

How have the injuries affected work or daily life?

Treatment

Identify where you went first and what treatment has followed.

Gaps in treatment matter, but you do not need every provider before submitting.

First treatment after incident

None same day ER or urgent care Primary care Ambulance Chiropractic Other

Treatment received

✓ER or urgent care ✓Primary care ✓Physical therapy ✓Chiropractic ✓Orthopedic ✓Imaging ✓Surgery recommended or performed ✓Mental health treatment

Are you still treating?

Any gaps in treatment?

Coverage

Identify the insurance or claim channels that may apply.

Hawai'i auto cases require early PIP screening. California auto cases generally do not use mandatory no-fault PIP.

Auto coverage and claim information

Your auto insurance

Other driver or owner insurance

Available coverages you know about

✓Bodily injury liability ✓UM or UIM ✓MedPay ✓PIP ✓Commercial policy ✓Not sure

Hawai'i no-fault / PIP screening

Use this section for Hawai'i auto or pedestrian/bicycle cases.

Was a PIP claim opened?

Yes No Not sure

PIP carrier / claim information

PIP benefits used so far

Any facts suggesting the case is beyond no-fault only?

Property / premises claim information

Incident report made?

Known property insurer or claims administrator

Records

Let us know what exists now. You can still submit even if you do not have everything yet.

Choose anything you already have or believe can be obtained.

Available records or evidence

✓Photos of scene ✓Vehicle photos ✓Police report ✓Incident report ✓Medical records ✓Medical bills ✓Insurance correspondence ✓Witness information ✓Surveillance or dashcam ✓Wage loss records ✓Employer disability note ✓None yet

Review and submit

Provide a concise summary. The submission email will be organized by section so the intake can be reviewed quickly.

Submitting this intake does not create an attorney-client relationship.

In a few sentences, what happened?

Missed work or wage loss

Anything urgent we should know?

I understand that submitting this intake does not create an attorney-client relationship and does not mean the firm has agreed to represent me.

Intake sent successfully.

There was a problem sending the intake. Please try again.

State, case type, and contact information are required. Most other questions can be answered later or with a best estimate.

Serious Facts. Serious Representation.

Take it Back. Start with the incident.

What matters early

What clients do not need

Contact information

Case Type

Incident

Collision details

Dangerous condition details

Liability

Auto liability and fault

Premises liability and notice

Injuries

Treatment

Coverage

Auto coverage and claim information

Hawai'i no-fault / PIP screening

Property / premises claim information

Records

Review and submit