Insurance Case Intake Form

This information will allow us an opportunity to become familiar with your assignment to formulate needs and strategies. No fees will be incurred or work initiated until we have presented a case plan and received your approval.

As a full-service investigative agency, Hawk Professional Investigations ensures our clients are up-to-date on the status of their cases. We will contact you to acknowledge receipt of your request by the next business day. If you have not been contacted by the end of the next business day, please call us and let us know.

Contact Information

Contact Name (required)

Company Name

Address

City, State, Zip

Work Phone

Fax

Best Contact (person, method & time)

Case Details

Client File#

Insured Name

Case Type

Date of Loss

Describe your request/objectives

How did you find us?

If you were referred by an attorney, HPI client, or friend, please list their name. If you found us another way, please let us know where.

Subject Information

First Name (required)

Last Name

Address

City, State, Zip

Home Phone

Cell Phone

Date of Birth

SSN

Marital Status

Dependents

Detailed Description

Vehicle

Vehicle Tag & State

Is the subject represented by an attorney?

Attorney Name:

Is the subject receiving benefits?

Is the subject working light duty?

If the subject is going to rehab, where?

Employer

Work Phone

Address

City/State/Zip

May we contact the subject's employer?

Work Schedule

Hobbies, Activities, Memberships & Schedules

Accident Description

Nature of Injury

Limitations & Restrictions

Scheduled Appointments

Please list any scheduled appointments such as medical, rehab, depositions, etc. Include dates, times, and locations.

Previous Surveillance

Has surveillance been conducted on this case in the past?

HPI Fee Structure

DAILY RATE: $800.00 PER DAY

Based on an hourly rate of $100.00 per man-hour. This rate is for any and all necessary, appropriate and approved investigative time applied to the assignment including surveillance, research, administrative/report writing and production. This 8-hour minimum day will also include mileage throughout Georgia and Florida. One hour per day, (30 minutes each way) is appropriated for travel time to and from assignments throughout the states of Georgia and Florida. Report preparation time is also appropriated at one hour per day.

HOURLY RATE: $100.00 PER MAN-HOUR

For any and all necessary, appropriate and approved time applied to the assignment that exceed the 8 hour minimum described above.

EXPENSES:

Billed at costs, including database fees, court records, as well as any and all necessary and appropriate expenses associated with the assignment.

Budget Days

Comments

I accept these terms on behalf of my firm/company and/or my client and I have the authority to approve these expenses as well as guarantee payment to Hawk Professional Investigations, Inc. I understand, agree and acknowledge that time applied to this assignment and the costs associated are not in any way contingent upon any particular results. All time applied to this assignment is compensable to Hawk Professional Investigations, Inc. at the fees described above, plus any applicable expenses.

Insurance Case Intake Form

If your need is urgent, call us immediately.
(770) 760-0071

All information submitted is considered confidential and privileged communication.

Insurance Case Intake Form

If your need is urgent, call us immediately. (770) 760-0071

All information submitted is considered confidential and privileged communication.

If your need is urgent, call us immediately.
(770) 760-0071