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    CEREBRAL PALSY
Does your child have cerebral palsy? Could a doctor error have been the cause?.
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    MRI/NSF ALERT
The FDA has issued a warning for the use of Gadolinium based contrast agents used in MRI scans.
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FREE Online Legal Evaluation - Possible Lifetime Benefits
Parents suspecting that their child's cerebral palsy may have been caused by medical negligence should contact an experienced attorney with a successful track record of litigating medical malpractice claims. Our doctor and nurses will review your information for Free, with no obligation.

Time is of the essence, as a statute of limitations applies to medical malpractice lawsuits. We will respond promptly to your request.
CONTACT INFORMATION
Name:

Email: 

Address:

Phone:



State:

  Zip:
Contact By:

When?  		 


ABOUT THE PERSON WITH CEREBRAL PALSY
Name:

Date of Birth / Age:

What is your relationship to the injured?   
Other:
Has a medical diagnosis of CP been made?   Yes  No
If a medical diagnosis of cerebral palsy has been made,
how old was the individual at the time of diagnosis?        
In what state was the child born?

MEDICAL INFORMATION

Was the delivery of the child particularly difficult?
Yes  No

Was the birth premature? Yes  No
Did the doctor declare 'fetal distress' during the delivery?
  Yes  No
Do you believe medical errors occurred during labor?
What form of cerebral palsy has been diagnosed?
Please mark all conditions that apply:
Spastic Diplegia
 Spastic Quadriplegia
 Spastic Hemiplegia
 Spastic Double Hemiplegia
 Seizures / Epilepsy
 Respiratory Difficulty
Vision, Speech, or Hearing Difficulties
Bone Abnormalities (Scoliosis)
Bowel or Bladder Problems
Learning Disabilities
Behavioral Problems
Other / Additional		  
Is full-time care required by either a parent or nurse?
Yes  No
Additional Medical Information:

ADDITIONAL INFORMATION

Have you previously sought legal assistance regarding a possible medical malpractice claim? Yes  No

Additional Information / Questions / Comments:
How did you hear about us:

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