We Are Medical Malpractice Attorneys

Fill out our medical malpractice form completely and your inquiry will be submitted directly to our attorneys for review. We will get back to you within 24-48 hours of receipt to let you know if we are able to help investigate your medical malpractice claim further. Breit Cantor Grana Buckner has helped recover millions of dollars for those who have experienced medical malpractice. We would be honored to help you get the results you deserve.

First Name*
Last Name*
If not calling for yourself, who is the injured person?*
Mailing Address*
Best Contact Number*
Email*
Occupation*
Employer*
Date Of Birth*
Age*
Male or Female*
How did you hear about us?*
Were you referred?*
If yes, by whom?
Were you referred to a specific attorney?*
If yes, who?
Please provide as much detail as possible below for us to better evaluate your potential claim:
Describe why you are contacting us about medical negligence - what happened?*
List all doctor(s), nurse(s), or hospital(s) that you believe are responsible for the malpractice*
When did this happen to you?*
Have you seen another doctor for a second opinion? Was that doctor critical of the care you received that caused the injury?*
Describe your injuries*
Are these injuries permanent?*
What are your medical bills to date?*
Do you have any photos of your injuries?
Drop files here or
List any prior surgeries*
List any prior hospitalization(s)*
List your current medication(s)*
List any pre-existing health condition(s) or diagnosis*
Are you a diabetic?*
Are you a smoker?*
Name
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We Are Medical Malpractice Attorneys

Please provide as much detail as possible below for us to better evaluate your potential claim:

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