When somebody is putting you in a bad light in print or verbally, you may have been slandered or defamed. These are legal claims that will depend on particular facts to prove liability. Below is an intake form that can help you and your lawyer to determine if the offending party has infringed on your legal rights. Take note that everybody has a free speech right, and that can extend to stating or announcing some things, although 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?
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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.
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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.
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______________________________________________________________________________
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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?
______________________________________________________________________________
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Who heard or read or saw the defamatory statement? Please be specific.
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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?
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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?
______________________________________________________________________________
______________________________________________________________________________
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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.).)
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Who else heard you make the alleged statement? Who read it? Who saw it?
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Was the statement true? Yes _______ No _______
If it was, please explain why you think it was true.
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Where did you get the information that formed the basis for the alleged defamatory statement?
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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.