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Help Them Understand.. People don't understand how many are harmed by bad doctors and what it is like for them. This information is intended only to drive awariness of harm and costs to all.
1.
Email Address - Only if your interested in meeting other participants from your state. (Responses will not be shared)
*
2.
Zip Code
(Required.)
*
3.
Were you or someone in your immediate family a victim of medical malpractice?
(Required.)
Yes
No
*
4.
Approximately, how much money did this cost your family in the first 5 years?
(Required.)
$0 to $20,000
$21,000 to $50,000
$51,000 to $75,000
$76,000 to $100,000
> $100,000
*
5.
Approximately, how much money did this cost your insurance company in the first 5 years?
(Required.)
$0 to $20,000
$21,000 to $50,000
$51,000 to $75,000
$76,000 to $100,000
> $100,000
*
6.
Will this injury lead to increased medical costs over the victim’s life?
(Required.)
Yes
No
N/A
*
7.
If you notified the media, did they print your story?
(Required.)
Yes
No
I did not contact them.
*
8.
Do you feel you were unfairly denied the right to a jury trial for any reason?
(Required.)
Yes
No
I did not attempt due to likelihood of failure.
I did not file a legal complaint
*
9.
Harm experienced, check all that apply?
(Required.)
Emotional Trauma
Financial Damages
Depression
Nightmares
Damaged Relationships
Chronic Pain or Functional Issues
Temporary or Permanent Disability
Inability to Work
Inability to Focus or Problem Solve
Tinnitus or other Stress Related Injury
Physical Imparments
Other (please specify)
10.
Any comments for legislators?
Current Progress,
0 of 10 answered