This Information Will Help Us Provide Your Child With Life Time Benefits

Please complete this form. The details you provide will enable us to determine how we can best assist you in securing life time benefits for your child. Please feel free to contact us if you need assistance in completing the form.

Personal Details

How long did mom carry?

Was mom's labor induced?

How did mom deliver?

Was mom connected to an electronic fetal monitor?

Did the doctor use forceps or was a vacuum extraction performed?

Did your baby have seizures, shakes or tremors within 48 hours after delivery?

Was your baby transferred to the Neonatal Intensive care Unit?

Was the pregnancy high risk?

*First Name:
*Last Name:
*Phone Number:
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Email Address:
Address:
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*Child’s age
Tell us your child's story:

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We Can Help You

Our legal / medical professionals will determine if you are entitled to life time benefits.

Our attorneys are experts in handing birth trauma cases and have recovered millions of dollars for clients.

LIFE TIME BENEFITS

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