Name *

First Name

Last Name

Phone

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###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Case type

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Personal Injury

Medical malpractice/negligence

Product Liability

Wrongful Death

Purpose for visual aids

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Focus Group

Mediation

Trial

Visuals needed

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Illustration

Animation

Color enhanced diagnostic images

Infographics (timelines, charts & graphs)

Document extracts

Not sure yet

Materials you can provide

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Pictures/Videos

Medical images (DICOM)

Reports

Format(s) of deliverables:

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Digital

Physical (printed boards)

Both digital and physical

3D printed

Date of trial

MM

DD

YYYY

Date of mediation

MM

DD

YYYY

Date of focus group

MM

DD

YYYY