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Learn if You Have a Claim Against Nursing Home Operators

Premature Deaths by the Thousands

Kahn Gauthier Swick is investigating possible legal actions against nursing homes to recover for injuries suffered by nursing home residents. There are more than one and one-half million elderly and disabled persons in 17,000 nursing homes across the United States.

Claimant Information

Are you submitting this information on behalf of yourself? Yes  No
Are you submitting this information on behalf of a family member? Yes  No
If yes, please provide: Name
Age
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Medical Information

Please describe the nature and extent of the injuries or damages suffered.
Please provide the date on which the injury occurred.

Nursing Home / Medical Provider Information

Please list the following information of the nursing home or medical care provider where the injuries or damages were suffered: Name
Address
City
State
Zip
 
Please detail the circumstances surrounding the injuries or damages listed above.
Have you previously retained an attorney to represent you in this matter? Yes  No

Personal Information

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Last Name
Street / Apt /
City, State Zip
Home Phone & Evening Phone (Same) . . & . .
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Date Issue/Problem

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