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Medical Malpractice Intake Form Date of first contact: Name & Address NAME: Address:SSN#:Telephone Numbers: Home: Work: Cell: Date of Birth:Referred by:Prior Counsel?Doctors/Facilities Involved.

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  2. Open the document in our online editor.
  3. Read the instructions to determine which information you must provide.
  4. Click on the fillable fields and include the requested info.
  5. Add the relevant date and place your electronic autograph when you fill out all other fields.
  6. Examine the completed document for misprints along with other errors. In case you need to correct some information, the online editing tool and its wide range of tools are at your disposal.
  7. Download the completed template to your device by hitting Done.
  8. Send the e-form to the parties involved.

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