Will you remember to ask the Dr. all the right questions?

Get this medical form and never forget again.

With this form you can help your doctor record important aspects of your injury from a medical perspective, and have a record to take to the railroad.

Ask your doctor to record his or her answers on this form to establish:

  • diagnosis
  • a causal relationship
  • restrictions on work


ATTORNEY ADVERTISING. Prior results don’t guarantee a similar outcome in your claim. This website and blog are for informational purposes and do not constitute legal advice, since only after knowing the details of your claim can any advice be provided. Please understand that particular laws vary by state. You must speak directly with an attorney about your situation to determine what laws apply.

Flynn & Wietzke, P.C.  1205 Franklin Avenue
Garden City, NY 11530
(516) 877-1234