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Online Attorney Questionnaire






Date: Client:
Attorney:
D/A: Type of Case:
In Suit? YesNo
Mediation Date: Award:
Plaintiff: AcceptReject Defendant: AcceptReject
Demand Amount: Offer Amount:
Case Value (opinion):
Settlement Prospects: GoodFairPoor
Settlement Expected: Within 30 days30-90 days90-120 daysOther
Trial Date:
Liability (Strengths/Weaknesses):
Injuries:
Prior Injuries:
Insurance Co: Claim #:
Adjuster's Name: Policy Limit:
Address:
Phone: Fax:
Defense Attorney: Case #:
Address:
Phone: Fax:
Attorney Fee: Litigation Cost:
Medical Liens: Other Liens:
Previous Lawsuit Funding Company:
Amount: Payback:
Additional Comments:

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