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Confidential Client Evaluation

Please answer the following questions that apply to you, with as much detail as possible so that we may fully evaluate and investigate the potential merits of your case:

Please identify the name of the treating physician(s), medical provider(s), and/or hospital(s) that you feel are responsible for your claim of malpractice:
Please describe the care and treatment that you feel was improper, who provided it, and what it is that your doctor/hospital did or failed to do in treating you or your loved one:
Injuries list all injuries/ disabilities/ death that you or your loved one sustained because of the above incident. If you are able, set forth whether you believe that the injuries will be permanent.
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