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Medical Negligence Questionnaire

Medical Negligence Questionnaire

Thank you for contacting us regarding your potential medical negligence claim. Our firm’s procedure is as follows:

You’ll find below some initial important questions that allow us to preliminarily evaluate whether we can assist you on your claim. Medical negligence cases are typically extremely technical and complex, as well often there are conflicts with our ability to sue certain providers (e.g., treating physician of our staff, client or other relationship). Please note, however, that everything submitted to us for a potential client is privileged—it cannot be disclosed (i.e., it’s confidential).

To have a viable, successful claim, an attorney must prove negligence, causation, and damages, and Nevada law most often requires at least one medical expert practicing in the same area as those involved to support the case with opinions under oath. Please respond to the questions below. Feel free to attach any supporting records, photographs or other evidence you think may be helpful for our review. If dropping anything off at our office, we cannot accept any original materials, rather only copies are to be provided.

Once received, one of our attorneys will review your information. Either the attorney or assistant will contact you with the decision and whether more information is requested. Please note that an attorney-client relationship is NOT formed unless and until there is an executed fee agreement between our firm and you. In other words, we do NOT represent you unless and until we take your case by you and us signing a fee agreement. Further, while we are reviewing your information to evaluate and investigate your potential claim, we will NOT be tracking or protecting any limitations deadline like the statute of limitations, which may be as little as one (1) year from injury or a related death. You need to protect your own statute of limitations until an attorney takes your case. So, while we are reviewing your potential case, you should strongly consider contacting other attorneys.

To determine whether hiring an attorney and proceeding with a claim is in your best interest because of the costs and risks, we need to ask about the extent of the damages caused by the potential medical negligence. Again, thank you for your time and inquiry.

Questionnaire Form

Fields marked with an asterisk (*) are required.
  • Please make a selection.
  • Please enter your name.
  • Please enter your address.
  • Please enter your City.
  • Please enter your state.
  • Please enter your zipcode.
  • Please enter your phone number.
    This isn't a valid phone number.
  • Please enter your email address.
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  • Please make a selection.
  • Please enter your answer.
  • Please make a selection.
  • Please make a selection.
  • Please enter your response.
  • Please enter a message.
    (We need the names to determine whether we may have a conflict of interest. For example, we cannot sue a doctor who is the treating physician for one of our existing clients.)
  • Please enter your response.
  • Please enter your response.
  • Please enter a message.
  • Please enter your answer.
  • Please enter your answer.
  • Please enter a message.
    (For example, do you have a medical opinion from a doctor, nurse or other; do you have an admission of guilt from a medical provider; a finding of negligence from medical board or internal investigation; and/or records or photographs.)
  • DAMAGES – PROVIDE YOUR ESTIMATES AS TO THE FOLLOWING DAMAGES YOU BELIEVE ARE RELATED TO THE MEDICAL NEGLIGENCE.



  • Please enter your answer.
    (Not your portion or what the insurance paid, but the total bills charged)
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  • INSURANCE



  • Please enter your answer.
    (Please specify if Medicare, Medicaid, or other.)
  • Please enter your answer.

Client Testimonials

Real Stories From Real Clients
  • “John Bertoldo spent hours with me explaining all legal matters and guiding me in this difficult time for me. The loyalty of this law firm was beyond my expectations. Great settlement and so happy with results!”

    - Mahir S.
  • “They made everything so seamless and easy for me and were always available for questions or reassurance. This law firm clearly not only cares about what they do, but the clients they do it for. Thank you, Javier and the whole team!”

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    - Aaliyah R.

Our Promise to You

Why You Can Count on Our Firm
  • Proven Record of Results

    We have recovered millions of dollars in successful verdicts and settlements for injured clients throughout the state of Nevada.

  • Experience You Can Trust

    Our attorneys, paralegals and support staff leverage decades of experience across a diverse range of backgrounds on behalf of our clients.

  • Committed to the Community

    We are proud to support a number of charitable organizations as a way to give back to the community we are honored to serve.

  • Client-Centered Approach

    We strive to treat our clients with integrity, compassion, and respect and provide them with clear communication every step of the way.

  • Comprehensive Legal Guidance

    Our attorneys will handle each aspect of your case, including securing short and long-term medical care, helping to recover lost wages and more.

  • Legacy of Client Satisfaction

    Word-of-mouth referrals and repeat clients account for more than 85% of our business, which is a testament to the level of service we provide.

Our Client-First Approach

When you've been injured, you want more than a great lawyer. You want a whole team of great lawyers who are committed to treating you with the compassion, integrity and serious respect that you deserve.