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Client Information
Client First Name
Client Last Name
Client Email
Client Phone Number
Client Company Name
Address Line 2
Address Line 1
State
City
Zip
Case Details
Claim/Client Reference Number
Have you previously requested an investigation on this claim
Have you previously requested an investigation on this claim
No
Have you previously requested an investigation on this claim
Yes
Claim Type
Workers Compensation
General Liability
Auto Liability
Life and Health
Disability
Mortgage
Maritime
Property
FMLA
Other
FECA
FELA
Is Subject Represented
Is Subject Represented
No
Is Subject Represented
Yes
CP Created from CP
Defense/Client Attorney
Attorney Type
Client Attorney
Plantiff Attorney
Defense Attorney
Phone
Email
Street 1
ZIP/Postal Code
City
State/Province
Services
Rush
Client Due Date
Surveillance
Unmanned Surveillance
Number of Days
Value must be Numeric.
Activity Check
Alive & Well Check
Court Appearance
Database Research
AOE/COE
Recorded Statement
Scene Investigation
Subrogation Investigation
SIU Investigation
Social Media Investigation
Business Due Diligence
Subpoena Service
Asset Check
Locate Investigation
Service of Process
Work Check
Record Retrieval
Geo-Fence
Vehicle Locator
Medical Canvass
Hospital Canvass
Pharmacy Canvass
Clinic Canvass
Primary Physician Canvass
Physical Therapy Canvas
Chiropractic Canvass
Other Canvass
SCORE Basic
SCORE Advanced
SCORE Platinum
Background Investigation
Background Basic
Background Comprehensive
Background Custom
Background Foundational
Background Business
Other
Assignment Instructions
Subject Information
First Name
Middle Name
Last Name
Date of Birth
SSN
Driver License
DL State
Aliases (AKA)
Occupation
Date of Hire
Subject Address/Telephone
Street 2
Street 1
ZIP/Postal Code
City
State/Province
Business Phone
Email
Home Phone
Subject Demographics
Gender
Male
Female
Height
Weight
Hair Color
Ethnicity
Other Description
Loss Description
Date of Loss
Injuries
Restrictions & Limitations
Description Of Loss
Treating Physician
Phone Number
Next Medical Appt
Street 1
Dr Appointment Time
Street 2
City
State/Province
ZIP/Postal Code
Subject Vehicle
Vehicle Description
Vehicle License Plate Number
Employer/Insured
OK to Contact Employer/Insured
OK to Contact Employer/Insured
No
OK to Contact Employer/Insured
Yes
Employer/Insured
Contact Name
Phone Number
Insured Email
Street 2
Street 1
ZIP/Postal Code
City
State/Province
Special Instructions
Trial / Hearing
AOE / COE Decision
Notes
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