Name*Email* Phone*Name of PatientAge at the Time of IncidentApproximate Date of IncidentWhere Incident OccurredAdditional Comments- What happened? How was your child hurt? Did Dr. Schneider do additional work than what was needed or what he said he would do? What do you know?Did you sustain monetary damages? Describe. Please check if you want to speak to or hire a lawyer. Please check if this information can be disclosed to law enforcement. Please check if you have photos. Please check if you have medical records or bills. This iframe contains the logic required to handle AJAX powered Gravity Forms.