New Client Intake

Let's build your case

Please complete this form as thoroughly as possible. The more detail you provide, the stronger your case. All information is strictly confidential.

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Your information

Basic contact details so we can reach you quickly.

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Your information is submitted securely and used only to evaluate your claim.

Full name *

Please enter your full name

Phone number *

Please enter your phone number

Email address *

Please enter your email address

Property address *

Please enter the property address

Best time to reach you

Morning

Afternoon

Evening

Anytime

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Section 2 of 3

Insurance policy

Your policy information helps us understand your coverage immediately.

Insurance company *

Please enter your insurance company

Do you know your policy number?

Yes

No, I don't know it

Policy number

Found on your insurance card or declarations page

Have you filed a claim yet? *

Yes

No, not yet

Please let us know if you've filed a claim

Claim number Has an insurance adjuster contacted you?

Yes

Scheduled but not yet

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Section 3 of 3

The damage

Tell us exactly what happened. The more detail the better.

Type of damage *

Please select a damage type

Date the damage occurred *

Please enter the date of loss

Cause of Loss

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Intake received

Thank you. L.R. Claims & Consulting has received your intake. We will review your information and be in touch within one business day.

✓ Your information has been securely submitted

✓ L.R. Claims & Consulting will review your case details

✓ Expect a call within one business day

✓ Phone: 818-336-0312