Medical Malpractice Checklist Let's find out if you have a viable medical malpractice case. Answer these questions to the best of your ability. Did you have a treatment-based relationship with a doctor, nurse or any other medical staff like a physician’s assistant or hospital staff? YesNoI don't know Did your doctor or medical staff bill you or your insurance? YesNoI don't know What was the name of the office or facility where you were treated? What state is this office or facility in? Do you believe you were harmed by your doctor or a member of medical staff? YesNo Do you believe your doctor lacked the proper skill to treat you? YesNo Do you believe your doctor was not careful when treating you? YesNo Did your doctor’s actions lead to an injury or physical pain? YesNo Did your doctor’s actions lead to mental anguish? YesNo Did your doctor’s actions lead to lost work and earnings? YesNo Did your doctor fail to diagnose you correctly? YesNo Did your doctor fail to warn you of any risks? YesNo What year did your treatment occur? When was the last time you experienced pain and suffering due to this? Was your doctor negligent in any other way? YesNo If so, how? First Name (required) Last Name (required) Email (required) Phone Number (required) If you answered yes to one of the first 3 questions and any additional questions, it is likely you have a medical malpractice case. Once you submit your checklist, we’ll be in touch. If you have any questions or you’d like to talk to us right now, call (570) 348-3711.