Medical Malpractice ChecklistLet's find out if you have a viable medical malpractice case. Answer these questions to the best of your ability. Please enable JavaScript in your browser to complete this form.Did you have a treatment-based relationship with a doctor, nurse or any other medical staff like a physician’s assistant or hospital staff? YesNoNot sureDid your doctor or medical staff bill you or your insurance?YesNoNot SureWhat was the name of the office or facility where you were treated? What state is this office or facility in? Do you believe you were harmed by your doctor or a member of medical staff?YesNoDo you believe your doctor lacked the proper skill to treat you? YesNoDo you believe your doctor was not careful when treating you? YesNoDid your doctor’s actions lead to an injury or physical pain? YesNoDid your doctor’s actions lead to mental anguish?YesNoDid your doctor’s actions lead to lost work and earnings?YesNoDid your doctor fail to diagnose you correctly? YesNoDid your doctor fail to warn you of any risks?YesNoWhat year did your treatment occur? YearWhen was the last time you experienced pain and suffering due to this?Was your doctor negligent in any other way?YesNoIf so, how? Please explain. Your Information *FirstLastYour Email *Your Phone NumberCommentSubmit
