Hawk Private Investigations - Detailed Investigation Information Form

Your Information (BOLD = Required)
Contact Name:
Company Name:
Address:
City, State, Zip:
Office Phone#:		Fax#:
Email:
Client File#:
Insured Name:
Date of Loss:
Case Type:
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
Subject Name:	First Last
Address:
City, State, Zip:
Home Phone#:		Cell Phone#:
Date of Birth:		SSN:
Marital Status:		Dependents:
Detailed Description:
Vehicle: (make, model, color)
Vehicle Tag:	State:
Represented by an attorney?
Attorney Name:
Receiving Benefits?		Working Light Duty?
Going to Rehab?
If going to rehab, where?:
Subject's Employer:
Employer Address:
City, State, Zip:
Work Hours/Days:
Work Phone:
Hobbies Activities Memberships & Schedules:
Contact Person:
Contact Phone:
May we contact employer?
Accident Description:
Nature of Injury:
Limitations/ Restrictions:
Scheduled Appointments
Are there any scheduled appointments such as medical, rehab, depositions, etc?
If Yes, list dates, times, and locations:
Previous Surveillance
Has surveillance on this case been conducted in the past? If Yes, please forward the prior report and any identifiable photos by e-mail, fax or US mail.

Budget
Budget:	days	In summary, The Hawkins Firm hourly rates for all Insurance Defense Investigations is $75.00 per man hour, plus expenses. This rate applies for surveillance, administrative, investigative and travel time. Expenses may include, but are not limited to, mileage, database fees, court records, travel expenses, contract labor, and all other necessary and appropriate expenses associated with your assignment. For a detailed review of our client service agreement CLICK HERE In Georgia, your assignments, regarding travel time and mileage, are billed from the nearest Hawk Private Investigations service location.
Comments: