Medical Malpractice Intake

If you have been injured in an accident or if you have incurred damages, my office can help. Complete the form below to provide us with some information about your situation. We will use the information to make a preliminary assessment, and contact you to schedule a free consultation.

The information you provide is held in the strictest confidence, and will not be shared with any other party for any reason.

If you prefer to send us a hand-written form, you may download the form and fax to my office at (775) 322-5484.

Click to download Medical Malpractice Intake Form Click here to download a PDF file of the Medical Malpractice Intake Form.