TYLENOL INTAKE

Contact Information
First name:
Last name:
Address
Zip
Phone: - -
Email
Please describe your case
Alternative Phone Number:

Actions
Action Taken
Name of Person Call Patched to:

Submit

Call Center Form Instructions
1. Select proper firm code.
(This will correspond with firm code in your rotation menu)

2. Select toll free number dialed.
(If no number is available, select No Number Available)

3. Fill out the form fields
(All Fields are Required)

4. Select the proper Action Taken.
(follow lead delivery instructions to either submit lead via email only or call transfer and submit lead combined

5. Press the “Submit” button .
(You will then need to reload or close out the screen for the next caller)

Required Fields