Personal Injury Client Intake Questionnaire 

Please complete the below questionnaire to the best of your ability.  To make your initial consultation as efficient as possible, we ask that you fill this out prior to our first appointment.  All responses will be kept confidential regardless of whether our firm chooses to take your case. Please note that filing out this questionnaire does not create an attorney-client relationship.  If you have questions or need assistance filling out this questionnaire, please call 919.694.0001 or email Kate Sanyer at kate@feltonbanks.com.  

Name *
Name
Address *
Address
Phone
Phone
Date of Injury *
Date of Injury
Estimate if exact amount unknown.
$
Estimate if exact amount unknown.
$
Include any information that may help us evaluate your case.
I understand that submitting this form does not create an attorney-client relationship. *