Submit A Case

Tell us what happened

Answer in your own words – plain language is exactly right. This tells the reviewing physician where to look. It costs nothing to submit, and nothing begins until you approve the fee and sign the review agreement.

About the patient

The person whose medical care is in question.

Patient's full name *

Patient's date of birth

Your name, if you are not the patient

Your relationship to the patient

If the patient is deceased

We have a death certificate

We have an autopsy report

Date of death

How to reach you

Phone *

Email *

Preferred way to contact you

Who referred you to us?

What happened

The five questions the physician review starts from.

Who Who do you believe did something wrong – which providers, facility, or staff?

What *What do you believe was done wrong? Take your time – this is the most important answer.

When When did it happen – and when did you first learn something was wrong?

Where Which hospitals, clinics, or facilities – include city and state. List all involved.

How it has affected you Your life, abilities, work, family – in your own words.

Future medical care Do you expect to need further care for the injury?

Two quick screening questions

Has any attorney previously reviewed or declined this matter?

Medical records currently in your possession

Please complete the required fields (marked *) and check the acknowledgment box.

Nothing is sent until the next step, where you confirm.

Review and send

Here is exactly what will be sent. If anything needs a fix, scroll up, edit, and press "Review My Answers" again.

Send by Email

"Send by Email" opens your own email program addressed to intake@mdmerit.com. If your answers are long and the email opens incomplete, use "Copy to Clipboard" and paste into a new email instead. We respond within one business day.