Medical Malpractice Questionnaire

Michael W. Goldstein is a New York lawyer handling many types of cases such as medical malpractice and personal injury cases throughout New York State since 1979. Michael W. Goldstein has substantial experience aggressively and effectively representing business and individual clients.

Please fill out the medical malpractice questionnaire below. Make sure to read this page and field within from top to bottom before filling out the medical malpractice questionnaire form.

Your Name (required)

Your Email (required)


Date of Improper Medical Treatment

Location of Improper Medical Treatment

Describe the Improper Medical Treatment

Describe Your Injuries and Treatment Caused by the Malpractice



Please click the Submit button. If you do not receive a confirmation message, an error has occurred. Therefore, kindly confirm the required fields (including Name and Email) and verify your answer to the security question. Then please submit this form again. If you are unable to successfully submit this form, please call us.

Notice: Your submission of this form, or a free telephone consultation, will not constitute an attorney-client relationship.


General Disclaimer

Visiting our website, submitting any information via questionnaire or email, or discussing your case with us does not create an attorney-client relationship. An attorney-client relationship with our law firm can only be established with the signing of a written retainer agreement prepared by our law firm.

Under New York law, in the event there is no recovery in a contingency fee case, the client is responsible for the expenses of the litigation, including court costs and disbursements.

Prior results do not guarantee or predict a similar outcome with respect to any future case or legal matter.

We keep all correspondence strictly confidential among our law firm and associated law firms, however, the confidentiality of any information sent over the Internet cannot be guaranteed. Furthermore, the submission of a questionnaire or email sent over the Internet might not be successfully delivered to our firm. Therefore, we cannot guarantee a response to your inquiry. If you do not receive a reply to your completed questionnaire, please feel free to call us.