Intake Form: Defamation or Slander

Available in PDF | MS Word

If someone is painting you in a bad light in print or otherwise, you may have been defamed or slandered. These legal claims depend on specific facts to establish liability. This intake form can help you and your attorney determine whether the offending party has intruded on your legal rights. Keep in mind, though, that everyone has a free speech right, and that can extend to saying or publishing certain things, even if they are negative.

Name: Address: Home Telephone(s):	____________________________________ ____________________________________ ____________________________________ ________________________ ________________________
Employer's Name: Employer's Address: Work Telephone(s):	____________________________________ ____________________________________ ____________________________________ ________________________ ________________________
May we contact you at work?	Yes _______    No _______
Why do you need legal advice about defamation? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Section I: If You Think You Have Been Defamed, please answer the following questions. Did the defamatory statement consist of specific words that were spoken or written? Yes _______    No _______ Please provide a brief description of circumstances of the defamatory or slanderous statement and what was said or published. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Did the defamatory or slanderous statement consist of some unspoken expression or act that implied something untrue or unsavory about you? Yes _______    No _______ Please explain the circumstances and describe the defamatory or slanderous act. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How long ago did the defamation or slander occur? In the last year _______ More than one year ago _______ More than two years ago _______ More than three years ago _______ If you know the precise date, please write it here: _____________________________________ Did the statement suggest any of the following? Check all that apply. That you are a criminal _______ a person of lax morals _______ a drunk or a drug abuser _______ an adulterer _______ an abuser of your spouse or children _______ an unfit parent _______ a liar _______ a thief _______ a cheat _______ Did the statement suggest that you cheat on your taxes _______ run a shady business, or engage in sharp practices _______ sell adulterated food _______ sell pirated goods _______ cheat your customers _______ swindle elderly people _______ Where was the defamatory statement made? At work in an open area _______ In a private meeting at work _______ In a performance review _______ At a meeting of your employer's executives _______ In a public place _______ At church _______ In your community _______ At a community meeting _______ Before the city council _______ Before legislators _______ In a communication to a governmental agency _______ In court _______ In a newspaper or magazine _______ In a book _______ Over the radio _______ On TV _______ On the Internet _______ How did you find out about the statement? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Who heard or read or saw the defamatory statement? Please be specific. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Was the defamatory statement directed toward your business? Yes _______    No _______ Do you think that the defamatory statement could have had a negative impact on your business? Yes _______    No _______
Section II: If you are being sued, please answer the following questions. What was going on when the alleged defamatory statement was made? What were the circumstances? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How long ago did the defamation occur? In the last year _______ More than one year ago _______ More than two years ago _______ More than three years ago _______ If you know the precise date, please write it here: _____________________________________ Who is the plaintiff and what does he or she do? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Is the plaintiff a public official? Yes _______    No _______ Is the plaintiff somebody well-known? Yes _______    No _______ Where did the alleged defamatory statement take place? (Consult the list in Section I.).) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Who else heard you make the alleged statement? Who read it? Who saw it? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Was the statement true? Yes _______    No _______ If it was, please explain why you think it was true. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Where did you get the information that formed the basis for the alleged defamatory statement? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Did you confirm the information with third person? Yes _______    No _______ Did you try to keep the information confidential if it was, in fact, given to you in confidence? Yes _______    No _______ Does your liability insurance cover defamation? Yes _______    No/Not Sure _______ No matter how you answer this question, have the policy, along with any amendments or riders to it, with you to the first meeting with your attorney.