Medicolegal contact

Contact a medicolegal adviser

Please use the form below to submit your medicolegal query. In the interests of patient confidentiality, please do not include any information that would allow a patient to be identified.

Membership number

Title

First name

Surname

Medical Council registration

Date of birth

DD/MM/YYYY

Address

Postcode

Email address

Telephone number

I practice in:

United Kingdom
Ireland
Hong Kong
Malaysia
Singapore
Other

My query relates to:

Claim
Criminal investigation
Defamation
Ethical/legal dilemma
Generic medicolegal advice
Inquest
Medical Council issue
Patient complaint
Other

Period of involvement (date of earliest interaction and date of last interaction with patient relevant to the incident giving rise to case)

From

DD/MM/YYYY

To

DD/MM/YYYY

Incident date

DD/MM/YYYY

Private practice (tick as appropriate)

Yes
No

At the time of the incident, what was your Specialty?

At the time of the incident, what was your location?

At the time of the incident, what was your seniority/ grade?

Name of hospital/ clinic

Brief anonymised summary: (please detail below)

Patient initials

Patient year of birth

MM/YYYY

Patient outcome

If applicable, patient date of death

DD/MM/YYYY

Please confirm the following:

I confirm that I have not included any information that would allow a patient to be identified

Contact a medicolegal adviser

Contact a medicolegal adviser

To request medicolegal advice please complete the form below and email it to [email protected] or you can call our 24 hour medicolegal advice line on 1800 936 077.

To request medicolegal advice please complete the form below and email it to [email protected] or you can call our 24 hour medicolegal advice line on
1800 936 077.