Birth Injuries Resource Center

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If your child suffers from cerebral palsy, Erb's palsy, PPHN or any other birth related injury, please fill out this form or call us at 1-800-682-9443 for a free case evaluation.

Contact Us

If your child suffers from cerebral palsy, Erb's palsy or any other birth related injury, please fill out the form below or call us at 1-800-682-9443.

The information you provide will only be used in accordance with our terms and conditions. By submitting this form, you certify that you agree to our terms and conditions and want us to contact you regarding your inquiry.

* denotes required fields

*Title

*First Name

Middle Initial

*Last Name

Address

*City

*State

Zip Code

*Phone Number (day)

Phone Number (eve)

*Did you take an SSRI during pregnancy?

Yes No

*Have you or a loved one suffered from cerebral palsy or Erb's palsy?

Yes No

Date of incident?

Please tell us the city and state where the incident occurred:

City:

*State:

Please provide a brief description of your concerns:

I understand that submitting this form does not create an attorney client relationship.

En Español | Blog | Discussion Group

Call us at 1-800-682-9443

Birth Injury Resource Center

Contact Us

Contact Us