Register a Professional / Medical Negligence Case
Use this form to register a medical or other professional negligence case with HCCC Legal Services. We will contact you within 48 hours to discuss your matter further. Your information will be encrypted.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What state were you receiving treatment when you were injured?
Please Select
New South Wales
Victoria
Australian Capital Territory
Northern Territory
Please give a short description of how you were injured.
Please list the injuries you have suffered that you consider were caused by professional or medical negligence?
What date did the injury occur?
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Have you have been to a court or a tribunal about this professional or medical negligence claim already?
Yes
No
My case is schedule for a hearing in the future
Has anyone been given legal advice about this claim?
No I have not had advice from another lawyer
Yes I have a current lawyer but I am thinking of changing
Yes, I have a previous lawyer regarding this case but they are no longer representing me.
Please attach any files you would like HCCC Legal to review in relation to this case. We will securely store these files and destroy them if we are unable to assist in this case.
Browse Files
Drag and drop files here
Choose a file
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How you would you like HCCC Legal Services to contact you for further discussion about your case?
By telephone during business hours
By telephone after hours
By video conference during business hours
By video conference after hours
By email
I will log on to the HCCC Legal Services contact page and arrange an appointment that suits me.
Submit
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