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Contact Information

Educise PC
P.O. Box 498 Newbury NH 03255
Info@Educise.com

Expert Consultation Intake Form

Attorney and Firm

Matter and Identification

Screening

Conflict Check

List every party, provider, facility, insurer, and attorney you know to be involved. Include names and locations. *

  • Plaintiff(s)
  • Defendant(s)
  • Treating providers and facilities
  • Insurer or claims professional, if any
  • Opposing counsel and firm
  • Any other person or entity Dr. Schmidt should screen

Have you, your firm, or any party in this matter had a prior professional relationship with Dr. Schmidt or Educise PC? (yes / no / unsure). If yes, describe.

Records and Timing

Engagement