Malpractice Form

To help you With a quick and complete response to the legal issue you are facing, please help us with filling out the following form.

Name

Telephone

1. Mention the medical specialty related to the malpractice situation (e.g. surgery, cardiology, dentistry, etc.).

2. Have you been treated in a public or private establishment?

3. For what intervention/treatment did you use the services of the medical unit?

4. What intervention/treatment/action of the doctor do you consider improper or defectively performed?

5. When did this happen?

6. Before performing the medical act, have you been explained the risks of the intervention?

7. Have you signed an information/consent agreement with the medical facility?

8. What is the damage you suffered as a result of the intervention?

9. Do you have medical documents?

10. Have you filed a complaint with the Public Health Directorate / College of Physicians / criminal complaint?

CONFIDENTIALITY AND PROTECTION OF PERSONAL DATA

We inform you that we comply with the legal provisions regarding the Protection of Personal Data and we implement technical and organizational measures to protect all operations performed in connection with personal data in order to prevent unauthorized processing, as well as to prevent accidental / illegal loss or destruction.

In accordance with Article 6 para. (1) of Regulation 679/2016, by completing this form, you agree to the processing of personal data to be provided by you, in order to carry out a preliminary assessment of the disputed issue raised, prior to concluding the legal assistance contract.

We also inform you that, in accordance with the provisions of Law nr. 51/1995 regarding the Statute of the legal profession, we undertake to ensure the confidentiality of all data, information and documents provided by you. by filling out the form, absolutely and unlimited in time.

MALPRACTICE FORM

Street Pictor Theodor Aman 42, Bucharest