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Defective Product (causing personal injury)
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(who caused the harm?)
Defective product causing personal injury
Describe your complaint:
(briefly describe the damages you have suffered)
Have you or a loved one been injured by a defective product?
If a loved one, what is your relationship?
What product caused the injury:
Who is the maker of the product?
Where did you purchase the product? (Store name):
When did the injury occur?
Was hospitalization required?
Were the injuries life threatening?
Do you have a copy of the medical records?
Can you get a copy of the medical records?
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