Homeowner Intake Form – Cohen Law Group | Insurance Claim Attorneys

Homeowner Intake Form (Workato)

Cohen Law Group. This is _____ speaking.

To whom do I have the pleasure of speaking with?

Cohen Law Group. This is _____ speaking.

To whom do I have the pleasure of speaking with?

May I ask how to spell your first and last names?(Required)

First Last

Thank you. What is the best phone number to reach you in case we lose connection?

Is this a cell phone number?

Would you like to receive text messages to this number from us?

Wonderful! What email address is the best to communicate regarding this matter?(Required)

Thank you.

Please - tell me what happened? (provide empathetic customer service)
--- "we're are sorry that you have had to go through this"
--- "I can understand this has been frustrating"

What happened?

Thank you. I have just a few more questions so I can provide as much detail to an attorney for review of your case. What is the address where the damage occurred?
Street Address Address Line 2 City State ZIP Code

Untitled

When did you purchase the home?
Month
Day
Year

Can you send me a copy of the purchase inspection?

Do you reside at this address?

Who owns the property with you?

What is your current mailing address?
Cur Street Add Cur Street Add2 Cur City Cur State Cur ZIP

Untitled

What was the date that the damage occurred?
MM slash DD slash YYYY

Was there roof damage?

Do you have flood damage?

Do you have flood insurance?

Do you have damage to the home’s interior? Or to personal property or contents (furniture, etc.)?

Do you have damage to other structures like patio screens, fences or sheds?

Did you incur additional living expenses, such as temporary housing, storage fees, meals?

Did you incur out of pocket expenses?

Out of pocket expenses - How much?

Did you make a Hurricane Irma claim for your property?

Are there any prior roof claims for this property?

Who is your insurance company?

Do you have your policy number? (enter policy number)

Has a claim been filed?

What is the claim number?

Do you have an estimate?

What is the estimate amount?

Thank you (name). What is your deductible amount?

Did you receive any payment from (insurance company)?

How much did you receive from your insurance company?

Did you receive a letter from your insurance company denying your claim?

Can you provide us a copy of the letter?

Have you ever worked with a public adjuster or another attorney for this claim?
Public Adjuster

Enter PA name

Prior Attorney
Prior Attorney

Enter attorney name

Thank you. Just a few more questions to be sure we have all the information needed.

Is there a mortgage on the property?

Who is your mortgage with?

Great! Is the payment status current?

Are you working with any company to complete repairs?

What is the name of the company?

Enter Sales Rep Name

Enter Sales Rep Contact Information:

Have the repairs been completed or is there still damage?

Do we have your permission to discuss your property damage claim with the contractor and ask them for documents and information?

Did you sign an assignment of benefits?

Thank you (name) for providing all of this information. How did you hear about Cohen Law Group and how we can help you?(Required)

The next step will be to take this information and have an attorney review and advise. I will be back in touch with you by end of day tomorrow with an update. To confirm your phone number is (confirm number) and your email address is (confirm email). Thank you (name of prospect) is there anything else I can do for you at the moment? Close out call.

The next step I will email you a link to electronically sign our representation documents. Your email address is (confirm email) correct? Great! Once you sign and return the agreement we can assign the file to an attorney and start moving on your case.

Are you near a computer or device that we can do through the documents together now?

Not a problem. I am sending you the email now.
Please call with any questions as you review the documents. We will be happy to help, I will follow up with you by end of day tomorrow. To confirm your phone number is (phone number).
Thank you (name of prospect) - is there anything else I can do for you at the moment?
Close out call.

Walk them through and sign them up.

(HVC INTERNAL) INTAKE ASSISTANT / CASE MANAGER(Required)

(HVC INTERNAL) LEAD ATTORNEY:

This field is hidden when viewing the form

(HVC INTERNAL) LOCATION:

Florida

MATTER CASE TYPE: