Medical Negligence Case Evaluation

We have found that it is much more effective to collect this initial information via an online questionnaire rather than from a phone conversation because it allows you to gather and organize important facts such as doctor names, facility names, dates, diagnosis and other details.  

In order to evaluate your potential medical malpractice claim we need some specific medical history and treatment information. This information is essential to the evaluation process.  We cannot evaluate your claim without your answers to these questions.  

  1. Please fill out medical malpractice questionnaire below.  
  2. We will contact you regarding any additional information that may be required by our case evaluation team--such as if specific medical records are required.    
  3. The case investigation team will review the information and contact accordingly.  

All Answers Are Strictly Confidential

The answers you give on this form are for our use only in the evaluation of a potential medical malpractice claim.  Although some questions may ask for personal information, all questions have a legitimate purpose. The thorough evaluation of your claim depends upon the accuracy and completeness of your answers.  

Medical Malpractice Case Evaluation Questionnaire

The thorough evaluation of your claim depends upon the accuracy and completeness of your answers. All answers are confidential.