If you have any questions, please reach out to Andrea Seiden at (914) 444-2216 or email andrea@jumpstart-sme.com

Form Completion Instructions

Please note that this form must be completed in a single session - you cannot save your progress and return to it later. If you don’t have an answer to a question, simply write “Will provide later,” and JumpStart will follow up with you to gather the missing information. We appreciate your cooperation!

For what type of case are you seeking an expert? *

Law Firm Name *

Lawyer First Name *

Lawyer Last Name *

Lawyer's Email *

Phone *

Paralegal Name *

Paralegal Email *

Paralegal Phone *

Adjuster's First Name *

Adjuster's Last Name *

Insurance Company Name *

Carrier's Email *

Contact Number

Plaintiff's Name *

Date of Birth (if applicable)

Defendant's Name *

Codefendant Names (if appropriate):

Codefendant 1

Codefendant 2

Codefendant 3

Claim Reference Number *

Lawfirm's Case Number *

Case Description *

Damages Claim *

If this is medically related case, for budgetary purposes, how many pages of records and documents do you estimate are associated with this case? *

Do you want JumpStart SME to engage our partner records management company to organize the documents going to the expert? *

Yes

Types of Expert(s) needed with their specific expertise

(Example: Construction expert with expertise in Delays or an Orthopedist with expertise in Brachial Plexus)

Type of Expert(s) / Expertise *

Expert Needed Date

Geographic Constraints *

Yes (please specify)

Geographic Details

Who is responsible for paying the expert's services? *

Only my firm

My firm and additional law firms

Contact Information the first additional Firm:

Firm Name

Lawyer's Name

Phone

Contact Information the second additional Firm:

Firm Name

Lawyer Name

Phone

Contact Information the third additional Firm:

Firm Name

Lawyer Name

Phone

Contact Information the fourth additional Firm:

Firm Name

Lawyer Name

Phone

Any special comments or instructions?

Comments or instructions, if there are any: