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Category 4:
Medical Malpractice
You need a lawyer to help you with a claim for injuries or
death on your behalf or on behalf of a friend or family member that
resulted because of a doctor or hospital’s failure to provide the proper
care and treatment.
We have great lawyers that can help you with your medical malpractice
case. Tell us how the claim arose, and we will try to help.
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Are you looking for a lawyer for yourself or for someone else?* |
Myself |
Someone Else |
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If you are looking for a lawyer for someone else, is it a friend or
family relation? |
Friend |
Family Member |
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Will you be paying the criminal lawyer for the legal services?* |
Yes |
No |
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Do you allege that the malpractice was caused by a doctor, a hospital
or both?* |
Doctor
Hospital
Both |
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Identify the doctor or hospital you believe is responsible for the
malpractice:* |
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Describe as best you can very briefly what type medical procedure or
act caused the injury or death:* |
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What was the approximate date that you became aware of the
malpractice causing injury or death?* |
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Briefly describe as best you can what injuries were suffered because
of the malpractice:* |
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Please identify the city and state where the malpractice occurred:* |
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Has the injured person missed any work, or is the injured person
expected to miss any work?* |
Yes
No
Not Applicable |
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If yes, how much work will be missed and how much does the injured
person earn per week? |
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If you know, approximately how much are the medical bills for the
injured person at this time? |
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If this is a death case, how old was the person that died as a result
of the malpractice? |
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Please enter your full name* |
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Please enter your email address* |
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Please re-enter your email address* |
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Mailing Address* (Street, City, State,
Zip Code) |
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Home Phone* (include
area code) |
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Cell Phone |
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Work Phone* (include
area code) |
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Note: Initially, LawyersYouNeed.com will only
provide your e-mail address to the lawyers who may be interested in
discussing your legal situation with you. Your mailing address and
telephone numbers will not be disclosed unless the attorneys certify
that there is a problem or malfunction with receiving or sending e-mail
to you. |
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Basic
Agreement and Terms of Use: |
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To submit this form, please enter the characters you see in the image |
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