Associated Medical Disorders
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Causes of Cerebral Palsy
Common Signs and Symptoms
Early Signs
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Is Your Child Entitled to Lifetime Benefits?
Medical Errors
Treatment
Types of Cerebral Palsy

If you your child has been diagnosed with cerebral palsy, due to medical error, you or your child may be entitled to lifetime benefits. To find out if you or your child is entitled to monetary compensation, completely fill out the form below.

Your submission will be forwarded to CounselSeek.com, who will have a lawyer handling medical malpractice claims review your claim. There is no charge or obligation for this free service.

Free Is Your Child Entitled to Lifetime Benefits? Consultation

Title:
First Name:	*
Middle Name:
Last Name:	*
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Case Information:

Child's Name:
Child's Date of Birth: (ex. mm/dd/yyyy)
Date of Incident:	*
City where incident occured:	*
State where incident occured:	*
What has the child been diagnosed with?

What is your relationship to the injured child?

Describe injuries suffered:
Doctor's name and address: (if known)
Hospital that delivered child:
Hospital Location (City and State):

Why do you feel that it the doctor's or hospital's
negligence caused the injury to the child?

Was this a vaginal delivery?*	Yes No
Is the child deceased?*	Yes No
If deceased, date of death:
Was there an autopsy performed?	Yes No

If deceased, what is the cause of death
as stated on the death certificate:

Case Description*
Please explain exactly what happened, trying to state
as thoroughly as possible who you believe was responsible
and why you believe that person was negligent:

Please explain the full extent of the victims injuries:

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