Contact Us & Free Case Evaluation

Toll Free: 1-800-CP-NEEDS

If your child has been injured during childbirth resulting in brain damage or other serious injury, you may be entitled to benefits. Fill out the form below and your submission will be sent to 1-800-CP-NEEDS where a lawyer will review your claim. There is no obligation or charge for this free service.

Name: *
Relationship to Child:
Mother's Name:
Mother's DOB:
Email: *
Home Phone: *
Mobile Phone
Other Phone:
Best Time to Call:
Address:
City:
State:
Zip Code:
Child's Name:
Child's DOB:
Child's Birth Weight:
Expected Delivery Date:
In What State Was Your Child Born?:
Name of Hospital:
Was This a Natural Birth or C-Section?:
Any Problems During Labor/Delivery?:
Was Your Baby Sent to the Intensive Care Nursery?
Any Medications Taken During The Pregnancy?:
Do You Have the Medical Records?:
About Your Case:
Please do not include confidential information
about your case.
* By using this free case evaluation form, you agree to the Terms and Conditions of use.