The “DO I HAVE A CASE?” Form - Tremblay Bois Avocats

Accueil » Medical Malpractice » The “DO I HAVE A CASE?” Form

If you or someone close to you believes he/she has been a victim of a medical error that could lead to a Court dispute, please complete and return the following form. This document will remain confidential.

First name*
Last name*
Email*
Home phone*
Office phone
Mobile phone
Address*
City*
Province*
Postal Code*
Victim’s date of birth
Victim’s name
Your relationship to the victim
Date of death (if applicable)
Is there an autopsy report?
- Yes
- No
- n/a
Date and briefly describe the events
Facilities where medical care was received (hospital, etc.)
Name of physicians and/or members of the nursing staff presumed at fault (if known)
Why do you believe an error was committed?
Other relevant information
This form and any answer you may receive do not in any way establish a lawyer/client relationship nor do they indicate that we have decided to represent you. Although Tremblay Bois does not commit to answer this transmittal, any reply you may receive will be brief and will not constitute a legal opinion. This reply will be free of charge..