Georgia's Workers Compensation Intake Form
READ THE FOLLOWING INSTRUCTIONS BEFORE SUBMITTING THIS FORM
INSTRUCTIONS: Please complete our Georgia Workers’ Compensation Intake form. Fill out what pertains to you, and try to answer each question to the best of your ability.
¤This is extremely important for current clients as it is much needed to help finish case/claim admission.
For Prospect Clients: This information will only be used to provide you with a free case evaluation. Our site is secured and the date is encrypted to ensure safe transmission of your personal information. Your social security number and address in not needed.
For Current Clients: This information will be used to finish processing your claim. This stage for current clients serve as the final stage in the initiation process.
If you have any questions or concerns, please let us know through the client portal or contact our office at (678) 304-8489.
ATTORNEY-CLIENT/ WORK PRODUCT PRIVILEGED. CONFIDENTIALITY NOTICE: Do not read this e-mail if you are not the intended recipient. This e-mail transmission, and any documents, files, or previous e-mail messages attached to it may contain confidential information that is legally privileged and/or protected. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that any disclosures, copying, distribution or use of any of the information contained in or attached to this transmission is strictly prohibited. If you have received this transmission in error, please immediately notify by reply e-mail or by telephone at (406) 257-7944 and destroy the original transmission and its attachments without reading or saving in any manner. Thank you.