Contact -- Medical Expert Witness - Request Form - Third Opinion MD

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Medical Expert Witness - Request Form

4/3/26

Submitted by client

Attorney Name

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Representing the Plaintiff or the Defendant?

Plaintiff Defendant{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Plaintiff\nDefendant"}

Client Name:

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Case Name:

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The city where the case is based:

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What is the allegation?

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What is the purpose of retaining an expert witness in acupuncture for your case?

{"type":"textarea","name":"__generic5","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"Which question(s) are you trying to answer?"}

When is the current trial date?

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What is the status of the case?

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Which expert witnesses have been retained thus far?

{"type":"textarea","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Please list the areas of expertise."}

Contact phone number with the area code.

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Email:

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Preferred mode of communication:

phone email either phone or email{"type":"checkbox","name":"__generic13","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"phone\nemail\neither phone or email"}

Is there anything else you would like to add?

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Thank you for your time to complete this form.