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Bertoldo, Baker, Carter & Smith - personal injury lawyers in Las Vegas, NV
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7408 W. Sahara Ave., Las Vegas, Nevada 89117

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.

Fields marked with an asterisk (*) are required

  • (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.)
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • (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.

  • (Not your portion or what the insurance paid, but the total bills charged)
  • Insurance

  • (Please specify if Medicare, Medicaid, or other.)
  • Drop files here or
    Accepted file types: jpg, png, pdf, doc, docx.
      (The name on the records must be of the potential new client, not the name of the person who is submitting for another party, i.e. child, parents, sibling, etc.)

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