Your First Appointment: Workers Compensation Clients

Your First Appointment: Workers Compensation Clients

Please use the following checklist to make sure that you’ve got all forms you need prior to our first appointment. You can print each one and fill it out as completely as possible. You will need Adobe Acrobat Reader to download the forms. Click here to download Acrobat Reader.

For convenience, you can also click here to print all the forms at once:

1. Potential Client Information Sheet. Please fill this out as completely as you can. By signing this form, you are attesting to the fact that all the information you have provided is true and accurate to the best of your knowledge and belief.

2. The Retainer Agreement is the contract that allows me to represent you. Representation is not effective until both the potential client and the attorney have agreed to representation of your case and have both signed the Retainer Agreement. As a potential client, you must sign in the space provided prior to meeting with the attorney.

3. The Medical Authorizations allow us to request your medical records from doctors, hospitals, physical therapists, etc. Without them, we cannot see this privileged information about your physical condition and progress. You need only to sign your name and include your address, social security number and date of birth. Please DO NOT date these forms.

4. Mileage and Prescription Forms enable you to more easily keep track of the mileage you travel to and from your doctors’ appointments and to keep track of the prescriptions you purchase. It is very important that you document your mileage and keep your prescription receipts.

5. It is important that you keep our office updated as to any changes in your address, work location, amount of pay, doctor’s orders and physical condition. You may do so by making a phone call or simply by sending us a letter advising us of the change.

6. The Client Tipsheet is a list of common sense tips for you to read over with your family so that you can protect yourself during your claim.