Thank you again for your interest. To better get to know you and your qualifications, please complete this questionnaire. Dr. Herman will be back in touch with you should we require additional information.
Some routine background questions: (please explain any 'YES' answers)
Have you testified before? YesNo
If yes, please explain.
At Trial? YesNo
Have you ever had your license to practice denied, suspended, revoked, limited in any way, or placed on probation?YesNo
Have you ever been denied privileges or had privileges acted on in any way?YesNo
Did you pass all licensing and specialty board exams on the first attempt?YesNo
Have you ever been sued for malpractice?YesNo
Have you ever been convicted of a crime?YesNo
Anything potentially adverse that we should know?YesNo
Please leave this field empty.
Please include your fee schedule for your forensic work.
Thank you for your interest and your replies.
I will be back in touch with you.