Who are you filling out this form for? *

Myself

Loved one

Name of Loved One *

Are they deceased? *

Yes

The nursing home resident is my... *

Do you have legal authorization to sign on their behalf? *

Yes

Unsure

While at the Nursing Home, did you or your loved one suffer from any bedsores / pressure wounds? *

Yes

When did the bedsore(s) / pressure wound(s) first develop? *

Less than 1 month ago

1 month - 1 year ago

1 - 2 years ago

More than 2 years ago

Are there photos of the bedsore? *

Yes

Can obtain later

Did your loved one sustain any additional injuries at the nursing home? *

Are you working with another law firm regarding this matter? *

Yes

Name of Nursing Home Facility *

State Nursing Home Is Located *

Your Name *

Your Email *

Your Phone *

I give my consent for an attorney, paralegal, or team member from Miller Kory Rowe or their co-counsel to contact me as soon as possible to address my questions. I agree to be reached by email, phone, or text message, which may include calls or messages made using automated systems, artificial intelligence, or pre-recorded and artificial voice technology. I understand that all inbound and outbound calls with the law firm may be recorded or monitored for quality and training purposes. By submitting this request, I agree to the Privacy Policy and Terms of Use, including provisions for mandatory arbitration and limited tracking of my interactions with this site (excluding case details). I acknowledge that standard message and data rates may apply and understand that providing this consent is not required to access the firm’s services.

Fast-Tracked Nursing Home Claim​

Fast-Tracked Nursing Home Claim