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Elder Abuse (senior abuse or neglect)
Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersAndSettlements.com.
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Defendant:
(who caused the harm?)
Elder Abuse (senior abuse or neglect)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Has elder shown signs of dehydration?
Yes
No
Malnutrition?
Yes
No
Bruises?
Yes
No
Pressure or bed sores?
Yes
No
Untreated pain?
Yes
No
Over or under medication?
Yes
No
Financial abuse?
Yes
No
Mental distress?
Yes
No
Weight loss?
Yes
No
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First name:
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Last name:
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Email address:
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Zip/Postal Code:
Best time & way to contact you:
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