Free Claim Evaluation
Medical Malpractice/Catastrophic Personal Injury
If you suspect that you have a case and that it may have been caused by medical mistake, malpractice or negligence, contact our office for a free evaluation by filling out the form below. This should be done as soon as possible to protect your rights under the applicable statute of limitations.
Full Name
Address
Phone
Email Address
When is the best time to contact you?
How would you prefer to be contacted?
Injured Name
Date of Birth
or Age
XXX-XXX-XXXX
Relationship to Injured:
Has a medical diagnosis been made:
Yes
No
If a medical diagnosis has been made, how old was the individual at the time of diagnosis?
If yes, please explain:
Yes
No
In What State did the Injury Occur?
Please describe your case can and tell us what you think went wrong.
Have you previously sought legal assistance regarding a possible medical malpractice or injury claim?
Contact Information
Information Regarding the Person with the Injury/Condition
Additional Information
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(952) 746-2186             Email Us
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DISCLAIMER: This request for a case evaluation does not constitute an attorney-client relationship, nor does the information on this website constitute legal advice. Neither the transmission nor receipt of these website materials will create an attorney-client relationship between sender and receiver.