Law Office of Barry K. Tagawa, P.C.

INITIAL CLIENT INTAKE FORM:
"Please note that all communications with The Law Office of Barry K. Tagawa, A Professional Corporation are confidential and protected by the attorney-client privilege, regardless of whether you are an existing client or a potential client.
I	YOUR NAME(S) (POTENTIAL CLIENT):

	ADDRESS:

	TELEPHONE NUMBER:

	FAX NUMBER:

	E-MAIL:


II	NAME OF YOUR INSURANCE CARRIER:

	TELEPHONE NUMBER:

	POLICY NUMBER:

	POLICY LIMITS:


III	YOUR PRIOR ATTORNEY (if any):
	ADDRESS:

	TELEPHONE NUMBER:


IV	NAME OF OPPOSING PARTY OR PARTIES:


	ADDRESS(ES):




	TELEPHONE NUMBER(S):



V	NAME OF OPPOSING PARTY'S INSURANCE CARRIER:

	ADDRESS:

	TELEPHONE NUMBER:

	POLICY NUMBER:

	POLICY LIMITS:


VI	ATTORNEY FOR OPPOSING PARTY (if any):


	ADDRESS:


	TELEPHONE NUMBER:


VII	DESCRIPTION OF THE ACCIDENT OR INJURY:




	WHEN DID IT OCCUR:

VIII	WITNESSES TO THE ACCIDENT OF INJURY:





	NAME:

	ADDRESS:

	TELEPHONE NUMBER:


	NAME:

	ADDRESS:

	TELEPHONE NUMBER:


	NAME:

	ADDRESS:

	TELEPHONE NUMBER:


IX	RELEVANT DOCUMENTS:


	POLICE REPORT:

	FINANCIAL DOCUMENTS:

	CONSTRUCTION DOCUMENTS:

	CITIZENSHIP DOCUMENTS:

	INSURANCE POLICY:

	MEDICAL RECORDS:

	CONTRACTS:

	RENTAL AGREEMENT:

	EMPLOYMENT AGREEMENT:

	DOCUMENTS EVIDENCING TITLE:

	PHOTOGRAPHS:

	OTHER:


The Law Office of Barry K. Tagawa, P.C. 57 Post Street, Suite 900 San Francisco, CA 94104 Tel: (415) 951-8600 Fax: (415) 951-8626 e-Mail: Barry@SF-Attorney.com

Š2000 The Law Office of Barry K. Tagawa, P.C. all rights reserved.