Intake Information Form – Kressenberg Mediations

Intake Information Form

Case style or Claim No.:

Nature of Case: (e.g. Wind/Hail, Personal Injury, etc.)

Plaintiff(s)

Attorney(s) for Plaintiff(s)

Plaintiff’s counsel’s e-mail address

Plaintiff counsel’s direct phone numbers

Paralegal

Paralegal’s e-mail address

Paralegal’s direct phone number

Defendant 1

Attorney for Defendant 1

Defense counsel’s e-mail address

Defense counsel’s direct phone numbers

Paralegal

Paralegal’s e-mail address

Paralegal’s direct phone number

Defendant 2 (if applicable)

Attorney for Defendant 2

Defense counsel’s e-mail address

Defense counsel’s direct phone number

Paralegal

Paralegal’s direct phone number

Paralegal’s e-mail address

Defendant 3 (if applicable)

Attorney for Defendant 3

Defense counsel’s e-mail address

Defense counsel’s direct phone number

Paralegal

Paralegal’s direct phone number

Paralegal’s e-mail address