Case Intake form

Name *

Firm/Company *

Email address *

Phone number *

Case Name / Identifier *

Court or Jurisdiction

Date of Filing

Status of Case

Please select at least one option.

Pre-Trial

Trial

Post-Trial

Settlement Negotiations

Other

Party Being Represented

Please select at least one option.

Plaintiff

Defendant

Other

Opposing Party

Primary Case Issues *

Specific Questions or Issues for Expert Review

Where to Focus when Reviewing Documents/Records

Expert Type Needed

Please select at least one option.

RN

LNHA

MD

DO

Dietician

Other

Deadline for Case Review *

Other Instructions / Notes

Attachments (Medical Records, Witness Statements, Photographs, etc.)

I confirm that I have permission to access and share the information provided, and authorize ECS to review the case details and provide a consultation. *

Please select at least one option.

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