Hi, Welcome to The Snyder Law Group. How can we help you?(Required) Birth injury Medical malpractice Car accident Could you briefly explain the situation for me?(Required) Personal information, Full Name?(Required) First Last Phone number?(Required)Email(Required) How did the birth injury happen?(Required)What was the approximate date of the medical care that caused harm?(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920In what city did this happen?(Required) And the state?(Required)Select a StateMarylandDistrict Of Columbia Where was the child born?(Required)Select a StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificWhere did the malpractice occur?(Required) Local hospital Private medical firm Private clinic Government based clinic VA hospital or clinic Other When did the accident occur?(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Did you suffer any injuries in the accident?(Required) Yes Someone else was injured Please select all the conditions your child has been diagnosed with related to the injury.(Required) Brain Injury Cerebral Palsy Erb's Palsy Nerve damage Lacerations Infection Suffocation (asphyxiation) Other What kind of injuries? Scroll down & select all that apply.(Required) Head & brain Back and neck Chest Arm & Leg Broken bones Soft tissue (muscle, tendons, etc.) Scrapes and cuts Other Please share details(Required)Where is the facility located?(Required)Select a StateMaryland Is there anything else you'd like to add about the condition of your child?(Required) Yes No Did they receive medical treatment for their injuries?(Required) Yes No Please Explain(Required) Please Click Next as you selected "No"What kind of medical care have they received so far? Scroll down & select all that apply. Ambulance (at the scene) Emergency room Urgent care cliinic Specialist doctor Regular doctor Medical tests Other Is your child currently receiving medical care? Yes No Are you the person that was injured? Yes No Have you lost wages due to your injury? Yes No What types of treatment are they currently receiving? (Choose all that apply) Medical Specialists Medical Procedures Occupational Therapy Physical Therapy Long term care facility In home nursing care Please take the time to type any other additional information about your matter that can help our team. If you don’t have any, please write 'none'Are there any other details that you would like me to know about the situation?Are there any other details that you'd like me to know about the situation?Is your loved one any of the following? Please select all that apply. Deceased In a coma Incarcerated Legally incompetent Disabled A minor Are there any other details that you would like me to know about the situation? If this information is correct, please submit and we will review as soon as possible.
