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 the form below with as much detail as possible. This information allows us to assess your case quickly and respond efficiently. All information remains strictly confidential.

Requestor’s Information

Company name

Contact Name

Cell Number

Office Phone

Ext

Title

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 Assignment Information

Is this a Rush?

Complete Investigation by

Deliver Evidence Package By

Evidence Package Delivery

File Number

Date of Loss

Name of Insured

Budget (Inclusive)

Insurance Claim Type

Client Instructions/ Case objectives

Subject’s information

Subject name

Gender

DOB

Subject Address

Cell Phones

Home Phone

Driver’s License No

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)

Contact Name

Cell Number

Office Phone

Ext

Title

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.

Intake Form

Intake Form

Hours

Intake Form

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