Dental Malpractice Cases — We Want To Hear From You

To assist with understanding your specific legal needs, fill out the online questionnaire below to help us evaluate your dental malpractice case. Answering each question as thoroughly as possible helps us assist you faster, more effectively, and helps save on case costs.

We always keep our clients' best interests in mind. This questionnaire allows us to provide you with customized help right away during your free consultation. Learn more about why this form is an essential part of our legal process.

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Personal Information

Are you a MediCal or Medicare recipient?


The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

Privacy Policy

This is a background summary to be used by the Hardwick Law Office for the sole and exclusive purpose of investigating the factual basis of your claim. THIS DOES NOT CONSTITUTE ACCEPTANCE OF YOUR CASE, nor agreement by the Hardwick Law Office to act in any manner on your behalf. In agreeing to review your case, we express no opinion (legal, factual, or otherwise) on any matter concerning your case, including, but not limited to, the merits of the underlying action, the liability of any alleged defendant, causation, or any issue related to the statute of limitations. Should you have any questions on any of the foregoing, independent counsel should be sought.

I SPECIFICALLY ACKNOWLEDGE AND UNDERSTAND THAT UNTIL A WRITTEN CONTRACT IS ENTERED INTO BETWEEN ATTORNEY AND CLIENT, ATTORNEY IS UNDERTAKING NO DUTIES TO ME REGARDING THE SUBJECT CLAIM.

Completion of the questionnaire will provide important information so that we may analyze and evaluate your dental/medical malpractice case. Please answer each item completely.

Please answer all questions truthfully, even if the information is embarrassing, or seems unimportant, or irrelevant in order to prevent surprises during litigation. All information you provide is confidential. If you fail to disclose information which is later discovered, it could seriously affect your credibility for truthfulness and jeopardize your case.

Do not discuss your case with anyone except your attorneys and family. You may, of course, discuss your dental treatment with your dentists and physicians. Do not discuss with your dentists and physicians the legal aspects of your case.

Notify our office promptly if any additional or new treatment is suggested, including specialist referrals; any person not from this office tries to obtain from you information about your case; or you change your address and/or telephone number.

Send us copies of all treatment records, x-rays, prescriptions, bills, and statements connected in any way with your case. Retain the originals in a safe place. We suggest you obtain a large envelope or file folder for your legal documents.