Medical & Clinical Negligence

Your Name *

Email Address

Telephone

Address *

City/Town *

Postcode *

How would you like us to contact you?

Telephone

Post

Is there a day and time of day that is best to contact you?

Name

(if different from above)

Relationship to you

(if applicable)

Have they have given you permission to speak to us about the potential claim?

Yes

Date of birth

Date of death

(if applicable)

Please let us know how you found Drummond Miller

Existing customer

Yellow pages

Word of mouth

Website

Other

Do you have any other solicitors acting for you or have you previously instructed solicitors in relation to this potential claim?

Yes

Have you made a written complaint about the medical care?

Yes

Has there been an investigation carried out by the GP practice / Health Board / Care Inspectorate / Scottish Public Services Ombudsman etc?

Yes

Documents

If there are any documents you would like us to review (e.g. a complaints response or investigation report) please email these to MedNegDM@drummondmiller.co.uk

Who and what does your criticism relate to?

To the best of your knowledge, please list the date(s) on which the care you are critical of occurred. If there are several dates please list these in chronological order, starting with the earliest date (month and year if possible)

When did you first think there may be failures in the care you received and why?

Please explain how you think the care should have been different

What difference do you think this would have made to your outcome?

Have any medical professionals confirmed this to you either verbally or in writing?

Are you currently undergoing treatment or will you require to undergo treatment in the future as a result of the medical issues this potential claim relates to?

What impact has the care you have described above had on you (physically, mentally and financially)?