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Medical Expert Questionnaire

We are pleased to have you submit an application to become a Mednick Associates medical expert.

To get started, please answer these quick questions for us.

Are you currently practicing in the field specified above?(Required)
Are you a faculty member at a university?(Required)
Has any board or committee ever taken action against you or to reprimand you, place you on probation, revoke, limit or otherwise affect your ability to practice?(Required)
Have you been denied membership or renewal thereof in any organization or institution?(Required)
Do you have malpractice insurance that is currently in effect?(Required)
Have you ever had any criminal charges files against you?(Required)
Have you ever had a malpractice case decided against you?(Required)
Have you settled (or had settled by your insurance carrier) a malpractice case against you?(Required)
Have you ever reviewed a legal case as an expert for the defense?(Required)
Have you ever reviewed a legal case as an expert for the plaintiff?(Required)

Name of attorney, law firm, address, email and telephone number

Max. file size: 256 MB.

Please upload in Word format. If you are unable to upload, please send your CV to us via regular mail, fax or email.

Max. file size: 256 MB.

If you are unable to upload, please send your fees to us via regular mail, fax or email

Max. file size: 256 MB.

If you are unable to upload, please send via regular mail.

Please click here to view our Expert Terms of Service Agreement. If you agree to our terms, then click Yes below.
Terms of Service Agreement