Jump To Navigation

Medical Device Product Liability Case - Intake Form

Name

Email Address

Phone Number

What is the name of the medical device you were using?

Who prescribed the device?

For what purpose or medical condition was it prescribed?

Was the device accomplishing that purpose?
Yes  No 

Who was monitoring your condition while you were using the device?

Where did you acquire the device?

Did anyone provide you with instructions regarding the device?
Yes  No 

Were you using the device properly when it caused you harm?
Yes  No 

How did the device injure you?

Was the device ever repaired? When and by whom? Describe the repair.

Was the device ever altered? When and by whom? Describe the alteration.

When did you first seek medical care for the injury caused by the device?

What is the current status of the injury caused by the device? Prognosis?

Copyright ©2009 FindLaw, a Thomson Business

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

 
Call us 24 Hours a Day 800-529-8008

NOTE: Labels in bold are required.

Contact Information
  1. disclaimer.

Payment Options are Available:
American Express Discover MasterCard Visa

An Affordable Financing Option for Legal Services
Learn About the Benefits of the Bailey & Galyen Legal Card

Ask us before hiring a personal injury attorney

Our expertise can help you with your case

Click To Call Now! 800-529-8008

Principle office:
1900 W. Airport Freeway
Bedford, TX 76022
817-868-5500
VIEW ALL OFFICE LOCATIONS

Dallas/Ft. Worth: 866-300-1529
Houston: 866-715-1529
Harlingee: 866-678-1900
Brownsville: 866-678-1900
Mesquite: 972-682-7868

SuperLawyersLexisNexis Martindale-Hubbell Peer Review Rated For Ethical Standards and Legal AbilityBBB