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Fill out the following in order to render your verdict.

* 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?
Caucasian
Black
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Other

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?
Under $15,000
$15,000 to $25,000
$25,000 to $40,000
$40,000 to $60,000
$60,000 to $80,000
$80,000 to $100,000
over $100,000

If employed, what kind of job do you have?

If you would like to be considered for our weekly drawing, please provide your name, phone number and e-mail address.

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