Help Them Understand.. People don't understand how many are harmed by bad doctors and what it is like for them. This information is intended only to drive awariness of harm and costs to all.

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* 1. Email Address - Only if your interested in meeting other participants from your state. (Responses will not be shared)

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* 2. Zip Code

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* 3. Were you or someone in your immediate family a victim of medical malpractice?

Yes

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* 4. Approximately, how much money did this cost your family in the first 5 years?

$0 to $20,000

$21,000 to $50,000

$51,000 to $75,000

$76,000 to $100,000

> $100,000

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* 5. Approximately, how much money did this cost your insurance company in the first 5 years?

$0 to $20,000

$21,000 to $50,000

$51,000 to $75,000

$76,000 to $100,000

> $100,000

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* 6. Will this injury lead to increased medical costs over the victim’s life?

Yes

N/A

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* 7. If you notified the media, did they print your story?

Yes

I did not contact them.

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* 8. Do you feel you were unfairly denied the right to a jury trial for any reason?

Yes

I did not attempt due to likelihood of failure.

I did not file a legal complaint

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* 9. Harm experienced, check all that apply?

Emotional Trauma

Financial Damages

Depression

Nightmares

Damaged Relationships

Chronic Pain or Functional Issues

Temporary or Permanent Disability

Inability to Work

Inability to Focus or Problem Solve

Tinnitus or other Stress Related Injury

Physical Imparments

Other (please specify)

Question Title

* 1. Email Address - Only if your interested in meeting other participants from your state. (Responses will not be shared)

Question Title

* 2. Zip Code

Question Title

* 3. Were you or someone in your immediate family a victim of medical malpractice?

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* 4. Approximately, how much money did this cost your family in the first 5 years?

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* 5. Approximately, how much money did this cost your insurance company in the first 5 years?

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* 6. Will this injury lead to increased medical costs over the victim’s life?

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* 7. If you notified the media, did they print your story?

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* 8. Do you feel you were unfairly denied the right to a jury trial for any reason?

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* 9. Harm experienced, check all that apply?

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* 10. Any comments for legislators?