Medical Malpractice 60-Second Questionnaire

DISCLAIMER:  This initial Medical Malpractice Questionnaire* will assist The Lapidus Law Firm, PLLC evaluate your potential case.  Unless and until a Contract for Legal Services is signed by both the client and an attorney at The Lapidus Law Firm, PLLC, no attorney-client relationship is established.  Thank you for affording us the opportunity to evaluate your case.  
What is your full, legal name? *
What is your phone number? *
What is the best time to contact you?
What is your date of birth?
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Approximate date of medical malpractice?
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Where did this incident occur?
Briefly describe what happened (NOTE: we will get more in-depth details if we decide to further explore your claim).
What specific injuries do you claim was caused by this wrongdoing?
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