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Medical negligence claim - enquiry form

If you or a loved one have been injured or suffered as a result of what you believe to be negligent medical treatment complete the claim form below and a member of our leading team of medical negligence specialists will contact you to discuss your claim for compensation. Alternatively you can call us on 0161 696 6165.

Please select your title
Please enter your first name
Please enter your surname
Please enter date of birth of injured person
Please enter your address
Please enter your post code
Please enter your phone number
Please enter your mobile number
Please enter your email
Please enter the date negligence happened
Please enter date you became aware of negligence
Please confirm type of injury
Please confirm loss of earnings
Please enter any additional information
Please select your preferred contact method
Please select how you heard about us
Please enter the verification code