Medical Malpractice Case Review | Wolf & Associates PLLC

Medical malpractice claims are subject to strict filing deadlines that vary by state and by the type of provider involved. The sooner we can review your situation, the better we can protect your rights. Everything you share here is kept strictly confidential.

Your Contact Information

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Preferred Contact Method

Best Time to Reach You

Mailing Address

Street Address *

Apartment / Unit

City *

State *

ZIP Code *

Identification

Your Social Security number helps us verify identity and check for prior claims. It is transmitted securely and kept strictly confidential. Providing it is optional — you may decline or indicate you don't have one.

Social Security Number

Enter Your SSN * 🔒 Encrypted in transit · kept confidential

Patient Information

Complete this if you are filing on behalf of someone else (a family member, a minor, or a person who has passed away).

Are You the Patient?

Patient's Name (if not you)

Your Relationship to the Patient

Patient's Date of Birth

The Medical Care

Doctor / Provider Name(s)

Hospital / Facility Name

City & State Where It Occurred

Type of Care Involved

Approx. Date Treatment Began

Approx. Date of the Error / Incident

When Did You First Realize Something Was Wrong?

Treatment History

List each provider, hospital, or facility that has treated you for this condition. Add a row for each — include when treatment started and when you were last treated (or check "still treating").

What Happened

Describe What Happened, in Your Own Words *

What Injury or Harm Resulted? *

Current Medical Condition / Status

Have You Received Corrective Treatment From Another Provider?

Photos & Documents

Optionally upload photos of your injuries, or images of medical records, bills, or correspondence. These files are kept strictly confidential, are shared only with our legal team, and will be destroyed upon your request. Large photos are automatically reduced in size before uploading.

📎

Tap to add photos or images

JPG or PNG · up to 15 images

I understand these images will be kept confidential, used only for evaluating my potential claim, and destroyed upon my request.

Case Background

Spoken With Another Attorney About This?

Already Filed a Claim or Complaint?

How Did You Hear About Us?

Acknowledgment

I understand that submitting this form does not create an attorney-client relationship and is not legal advice, and that no such relationship exists until a written agreement is signed. The information I have provided is true to the best of my knowledge. *

I consent to Wolf & Associates PLLC contacting me about my inquiry by phone, email, or text.

Thank You — We've Received Your Information

A member of our team will personally review your intake and reach out to you. Because medical malpractice claims are time-sensitive, if your matter is urgent please call us directly at (212) 608-1660.

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Medical Malpractice Intake

Thank You — We've Received Your Information