Hire Gravitas Investigations | Gravitas Investigations

1Contact Info

2Employer's Info

3Subject's Info

4Case Info

Client Name *

First

Last

Client's Company's Name *

Client's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Client's Best Phone Number *

Client's Email Address *

Employer's Information

Who employs your Subject / Claimant?

Is the Employer Information the same as the Client Information above?

Employer Contact Name

First

Last

Employer's Business Name

Employer's Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer's Best Phone Number

Employer's Email Address

Subject's Name *

First

Middle

Last

What is the name of the person (AKA, The Subject) being investigated?

Aliases / AKAs / Maiden Names

First

Last

Social Security Number (SSN) *

Current Address (No PO Boxes) *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *//

Best Phone Number

Gender *

Race

Height

Weight

Hair Color

Eye Color

Other Identifiers

Known Hobbies or Activities

Known Social Media Profiles and/or Usernames

Known Vehicles

Spouse's Name

# of Dependents

Select a Case Type *

Other Case Type

Claim Number / Case Number

Type of Loss / Injury

Date of Loss / Injury (if applicable)//

Medical Provider / Physician of Record (POR) (if applicable)

Upcoming Appointments / Known Future Locations

Physical Restrictions

Service Request Type *

Covert Surveillance
OpenEye Search (includes Social Media Canvass and Tracking)
Social Media Canvass (and Tracking)
Hospital Canvass
Alive and Well Check
Background Check (For Preemployment and Tenant Screening only)
Other

Tracking Duration:

Daily (12 days)
Weekly (12 weeks)
Monthly (12 months)

Canvass Locations / Radius: *

Number of Locations: *

Location Type/s: *

Hospitals
Urgent Care Clinics
Doctor’s Offices
MRI Facilities
Pharmacies
Chiropractors
Gyms / Health Clubs / Fitness Centers
Medical Centers
Orthopedic Specialists
Physical Therapists
Pain Management
Other (please specify)

Canvass Search Address

Use Subject’s / Claimant’s Address

Canvass Search Address (specify a location):

Address Line 1

Address Line 2

City

State

Zip Code

Other:

Other Service Type

Red Flags (What led you to suspect abuse, fraud, and/or wrongdoing?) *

Budget *

Your answer should include the total dollar amount you’d like to spend or the number of surveillance days

Objectives *

Special Instructions

Do you have additional documents to provide? Upload them here (Medco 14, previous investigations, pictures):

Click or drag a file to this area to upload.

Due Date / Deadline//

Where should we send the final invoice? *

To the Client (You)
To the Employer
A Third Party

Choose all that apply

Who is the Third Party?

Captcha *

What is 7+4?