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Expert Questionnaire

We are pleased to have you submit an application to become a Mednick Associates expert. To get started, please answer these quick questions for us:

What is your area of expertise?

How many years of experience in this particular field do you have?

Are you board certified? If yes, when does it expire?

What is your email address?

What is the best telephone number to reach you?

Are you currently practicing in the field specified above?

YES

Has any board or committee ever taken action against you or to reprimand you, place you on probation, revoke, limit or otherwise affect your ability to practice?

YES

Have you been denied membership or renewal thereof in any organization or institution?

YES

Do you have malpractice insurance that is currently in effect?

YES

Have you ever had any criminal charges files against you?

YES

Have you ever had a malpractice case decided against you?

YES

Have you settled (or had settled by your insurance carrier) a malpractice case against you?

YES

Have you ever reviewed a legal case as an expert for the defense?

YES

Have you ever reviewed a legal case as an expert for the plaintiff?

YES

Are you a faculty member at a university?

YES

Upload your current CV or resume

If you are unable to upload these items, you may send them via email info@mednickassociates.com, regular mail or fax.

I Agree to Expert Terms of Service Agreement *

Yes

Please click here to view our Expert Terms of Service Agreement and then click this box to agree to these terms

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