Clinical/Medical Negligence - Online Claims

1. Your Details

*Name

Address

*Email Address

*Telephone Number

2. Information regarding the negligence

Give the date upon which, or the period during which, the treatment complained of was given

Confirm the date when you were first aware that the treatment provided may have been negligent.

Give details of the party involved e.g. hospital/GP/Dentist. If hospital/dentist provide full name of any specialist and other staff involved and identify the hospital and practice.

Have any admissions (whether verbal or in writing) been made by those providing treatment to you? If so, please provide details.

3. Click below and submit your claim to us