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× Drum Circle Meditation Journey Monthly Meetup Drum Circle
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 $11.00
$11.00
× Energize Your Life Webinar– Put Yourself in a Better State of Mind-Body-Spirit Energize Webinar
Details Information:
 $25.00
$25.00

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Subtotal $36.00
Total $36.00
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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