Potential Expert Witnesses, please provide us with the following information:

(All information will remain strictly confidential.)

Name
*** E-mail
Organization Name
Address1
Address2
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
Preference
Board Certified? YES NO
For Board Certified Professionals Only:
Area Of Specialty
I Prefer To Be Contacted By...
Phone FAX E-mail  (check all applicable)

All Expert Applicants: Please e-mail, fax or mail your current CV, including license and/or Social Security number and current Fee Schedule to Sylvia J. Mobley, MSN, RN, your EW&CG Medical Consultant. When sending your information, please save it as a standard Microsoft Windows Word document. All information will remain strictly confidential.

I will be sending my CV and Fee Schedule by...

Regular Mail FAX E-mail  (check all applicable)

 



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Expert Witness & Consultant Group
THE LEGAL PROFESSION'S MEDICAL & SCIENTIFIC PARTNER
4601 Hunting Hound Lane
Marietta, Georgia 30062-6339
(Metro Atlanta Area)
PH: 770-587-0740; 404-943-9771
Fax: 404-303-7781
No Geographical Limitations
Email: ewcg@bellsouth.net
©2005 Updated - www.ew-cg.com - All Rights Reserved