NURSING HOME ABUSE FREE CLAIM EVALUATION
Abuse of the elderly in nursing homes is unfortunately not a new issue. Fellows & Blake are making a priority of prosecuting nursing homes for abuse. We are committed to taking nursing homes to task if they fail to meet the needs of our elderly. Whether it is an issue of under staffing, providing inadequate nutrition, improper health care, tolerating physical or sexual abuse, or otherwise not meeting the requirements of the law in protecting these vulnerable adults, Fellows & Blake has experience in litigating against nursing homes and residential care facilities. We conduct a comprehensive investigation to uncover the truth behind the harm to these helpless victims. Often we find that the neglect is a result of deliberate under staffing by the nursing home in an attempt to increase their profits. Quality of life demands that our aged be given appropriate care in their final years. When all that is left is their dignity, we cannot tolerate that being taken from them too. Please note that once you have completed and submitted this form, a representative of Fellows & Blake will be contacting you. This does not constitute a contractual attorney/client relationship. Once we contact you, we will notify you as to whether or not we feel we will be able to represent you in this matter, and will then request further, more detailed information.
* Items are required. There is no charge for this evaluation.
Contact Information
*First Name:
*Last Name:
*Email Address:
Cell Phone:
Work Phone:
Home Phone:
Street Address:
Address #2:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
Patient Abuse/Injury Information
If you are
NOT
inquiring on your own behalf, what is your relationship?
Is the person deceased?
Yes
No
If deceased, the cause of death as stated on the death certificate:
Date of Death:(DD/MM/YY)
Was an autopsy performed?
Yes
No
Enter the names of the doctors or nursing home workers responsible:
Describe neglect or abuse:
Do you feel the incident involved any of the following (please check all that apply):
Yes
No
Inadequate Nutrition
Yes
No
Inadequate Health Care
Yes
No
Sexual Abuse
Yes
No
Physical Abuse
Yes
No
Not Enough Care Givers
Yes
No
Failure to Follow the Care Plan
Please describe any injury(s):
Other Information:
How did you hear about us?
Select
Direct mail
Print Ad
Print Directory
Radio
Referral
Search Engine
TV
Web Directory
Yellow Pages
Other
Yes
No
- I agree that this matter may be referred to an attorney in my area who may contact me.
Yes
No
- I agree that by submitting this question, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.
Yes
No
- I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.
