Get Medical Malpractice Intake Form - Matthew D. Kaplan, Llc

Completing the Medical Malpractice Intake Form is an essential step in seeking legal assistance for medical malpractice cases. This guide will walk you through each section of the form to ensure that all necessary information is provided accurately and thoroughly.

Follow the steps to fill out the form effectively.

1. Select the ‘Get Form’ button to access the Medical Malpractice Intake Form. This will open the form in a suitable document editor for you to fill out.
2. Begin with the date of the incident. Fill in the date and time fields with the appropriate information regarding when the incident occurred.
3. Provide your name, today's date, street address, city, state, zip code, and social security number in the designated fields to ensure accurate identification.
4. Enter your home phone number, work phone number, cell phone number, and date of birth. Include your age as part of this information.
5. If applicable, fill in the name of your spouse or partner, and provide details on how you were referred to the attorney.
6. Move on to the 'Medical Malpractice Information' section. Here, write down the identity of the doctor or hospital involved, along with the dates when you started and ended your treatment.
7. In the subsequent questions, describe what led you to believe that harm was caused by a healthcare professional, and whether you received any apologies regarding your care.
8. Indicate if any documents were signed regarding treatment risks or arbitration agreements prior to your medical care.
9. Answer questions about your relationship with the doctor and whether the physician was assigned to you by a hospital.
10. Provide an explanation of why you sought care, the current status of your condition, and detail the treatment received and its results.
11. Indicate if you are currently under a doctor's care and provide your diagnosis and prognosis.
12. Once the form is completely filled out, save your changes. You may also download or print the form for your records or share it as needed.

Complete your Medical Malpractice Intake Form online today to ensure a thorough review of your case.