Jensen Belew & Gonzalez Law Firm, Fort Worth, Texas, Personal Injury Lawyers And Drug Litigation Attorneys

Online Jury Verdict

Fill out the following in order to render your verdict. Required fields are noted with a (*).

* Which way are you leaning as to who whould "win" this case?

	The Plaintiff, Ms. Doe
	The Defendant, Dr. Blank

* Do you believe that Dr. Blank was negligent in his medical care of Ms Doe?

	Yes
	No

* Do you believe that Ms Doe’s death and/or prolonged condition was a result of Dr. Blank’s negligence?

	Yes
	No

* If you believe that Dr. Blank was negligent, do you think that Ms Doe deserves to be compensated?

	Yes
	No

* What is the total amount, if anything, that you would award to Ms. Doe?

* How much, if anything, would you award to Ms. Doe for medical costs?

* How much, if anything, would you award to Ms. Doe for pain and suffering?

* How much, if anything, would you award for lost earnings?

* How much, if anything, would you award for wrongful death?

* Please explain the reasons for your decision:

* What did you feel were the strongest arguments in the case?

What is your gender?

	Male
	Female

What is your race?

What is your age?

What is your level of education?

	Did not graduate high school
	High school graduate
	Some college or tech school training
	Associates degree
	Bachelors degree
	Post-graduate degree

What is your family income level?

If employed, what kind of job do you have?