Intake, Authorizations & Contracts

Bicycle Intake Form https://form.jotform.com/231924674818163

MVA Intake Form https://form.jotform.com/231925736089163

Pedestrian Intake Form https://form.jotform.com/231925907205153

General Intake Form https://form.jotform.com/231925951018154

To Client:

Please click on the link provided below.  Select the green “Start Signing” box in the
upper right corner and provide your name and e-mail address. On the screen you
will see a blue box that says “signature,” click on this box. In the pop up you
will be given a choice of “type” or “draw” select draw and complete your
signature using your mouse. Hit submit when finished.

 

Authorizations

UH Authorization https://www.jotform.com/sign/232064862435052/invite/01h69mfkhy1cad460ed90b57b0

 

Standard HIPAA  https://www.jotform.com/sign/232623537265053/invite/01hascgerj1e30a5d77105bd88

 

Aultman Release https://www.jotform.com/sign/232623591334050/invite/01hase52cd100fbbdc4683b77e

 

 

Contracts

Knabe Atty Agreement PI – One Third & 40% After Trial

https://www.jotform.com/sign/232624043510039/invite/01hasj5b6g482937b7acef9514

 

Knabe Atty Agreement PI – 25% & One Third After Lawsuit

https://www.jotform.com/sign/232624284691056/invite/01hasctnfbd19d906d1a081645

 

Knabe Atty Agreement PI – One Third & 40% After Lawsuit

https://www.jotform.com/sign/232623860015045/invite/01hasczaafd650f09bb6f7c4bd

 

Knabe Atty Agreement PI-investigative Contingent 25% Prior
Trial

https://www.jotform.com/sign/232623540735049/invite/01hasd1wha725e7eb857c74d78