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Becker & Mishkind, Co. L.P.A.
1660 West Second Street, Suite 660
Cleveland, OH 44113
Phone: 866-435-1682

Who do you believe is the victim of the medical negligence and what are their injuries?

Did the medical negligence result in the death of a loved one?

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No

Why do you feel that you or your loved one has been the victim of medical negligence?

When did the negligent act(s) likely occur?

Please briefly describe your or your loved one's injuries and how that has impacted your day to day functioning


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