Sarasota Car Accident Attorney > Medical Malpractice Intake

To obtain a free review of your potential medical malpractice matter, please complete the form below and someone from our office will review your matter promptly and get in touch with you following our review.

Medical Malpractice Form

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Your Name*

First Last

Injured Party*

If OTHER

First/last Name

Date of Birth*

(Injured Party)

Date of Injury*

Death Involved?*

Does this case involve a death?

Married?*

If yes, was the deceased married at the time of the incident?

Children?*

If yes, did the deceased have children under the age of 25 at the time of the incident?

Preferred Method of Contact

Your Email Address*

Email Address Confirm Email Address

Your Phone*

Best Time to Call You*

Facility Information*

Full Name of the Facility, Medical Practice, or Physician(s) Involved in the Negligent Care

Brief Description*

Brief Description of the Alleged Negligence

Source*

How did you hear about Hale Law?

Phone

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Medical Malpractice Form

Next Steps: Sync an Email Add-On

AGGRESSIVELY FIGHTING FOR OUR CLIENTS
TELL THE INSURANCE COMPANIES,
YOU'RE GOING TO HALE™

Patrick M. Hale

A 5th generation Floridian who cares about the people of this great state.

Schedule A
Consultation

Medical Malpractice Form

Next Steps: Sync an Email Add-On

AGGRESSIVELY FIGHTING FOR OUR CLIENTSTELL THE INSURANCE COMPANIES,YOU'RE GOING TO HALE™

Patrick M. Hale

A 5th generation Floridian who cares about the people of this great state.

Schedule A Consultation

AGGRESSIVELY FIGHTING FOR OUR CLIENTS
TELL THE INSURANCE COMPANIES,
YOU'RE GOING TO HALE™

Schedule A
Consultation