Intake Form

The most information we can make determinations about the subject’s habits and life before we start our investigation. This way we can cut out wasted time and hours, gather evidence quicker, and more efficiently

If you experience any issues filling out the form click Contact below or call (519) 697-2563 and our team will be happy to assist

Hours

Today By Appointment

Mon 09:00 a.m. – 05:00 p.m.

Tue By Appointment

Wed By Appointment

Thu By Appointment

Fri By Appointment

Sat By Appointment

Sun By Appointment

Intake Form

Please complete this form in full and with as much detail as possible. The information provided allows Investigation Solution Services Inc. to assess the assignment, confirm scope, and respond promptly. All information submitted is treated as confidential and is used solely for the purpose of evaluating and, where retained, carrying out the requested investigative assignment.

Requestor's Name

Company Name

Contact Name

Cell Number

Office Phone

Ext.

Title / Position

Email Address

Address Line

Address Line 1

Unit

Address Line 2

City

Postal Code

If different from the contact above

Invoice to the attention of (if different from contact above):

Address Line 1

Unit

Address Line 2

City

Postal Code

If different from the contact above

General Description of Assignment

Is This a Rush Request?

Requested Completion Date

Requested Evidence Package Delivery Date

Preferred Method of Evidence Package Delivery

File Number

Date of Loss

Complete this section only if this assignment relates to an insurance claim.

Name of Insured

Approved Budget (Inclusive of Disbursements and Applicable Taxes)

Insurance Claim Type

Client Instructions/ Case objectives

Subject name

The Client confirms the information in this section is accurate to the best of the Client's knowledge.

Gender

DOB

Subject Address

Cell Phone

Home Phone

Driver's Licence Number

Physical description of the subject. (height, weight, build, hair color, style, and length, facial hair, complexion, distinguishing features, wears glasses, etc.)

Will you be providing a photo of the subject by email?

Has the subject been investigated before?

Vehicle Information

Does the subject own or have access to a vehicle?

If yes, please provide vehicle details. (I.e. Make, model, color, year, license plate number, any distinguishing features)

Vehicle #1

Vehicle #2

Subject’s Employment information

Please provide the subject’s employment details. (Ie. Current employer and location, occupation, shift start and end time)

Employer Contact Name

Complete this section only if this assignment relates to a workplace injury or WSIB claim.

Cell Number

Office Phone

Ext

Employer Contact Title

Employer Contact Email

Date of Injury

Have modified duties been offered?

Date of Injury

Nature of Injury

Current Restrictions

Name and Address of physician or other medical service providers

Next appointment, if known

By clicking here, the client agrees there has never been a charge of stalking or aggravated stalking (including cyber-stalking) against me (CLIENT) for this individual(s) (Subject)

By clicking here, the client agrees there is no restraining order, peace bond, protection order or any other such order against the client or associated parties for this individual(s) (Subject).

By clicking here, you agree to our terms and conditions and understand that private investigative services are non-refundable, except for paid retainers; in such cases, the remaining balances would be returned to the client.

Confidentiality Agreement(Required)

CLIENT CONFIDENTIALITY AND USE OBLIGATIONS: The Client acknowledges and agrees that all reports, photographs, video recordings, exhibits and other investigative materials provided by Investigation Solution Services Inc. are confidential and may be used only for the purpose identified in the assignment. The Client shall not alter, selectively reproduce, mischaracterize, publish, distribute or disclose any investigative material to an unauthorized third party. Where disclosure to legal counsel, an insurer, a court, a tribunal or another authorized recipient is reasonably required, the Client shall provide the material in complete and unaltered form. The Client accepts responsibility for any unauthorized, misleading or improper use or disclosure occurring after the investigative materials have been delivered to the Client or the Client's authorized representative.

Intake Form

Intake Form

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Intake Form

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