Medical Malpractice Tribunal Volunteer Sign Up Form

Qualifications: 

To volunteer you must:

  1. Have an active medical license in Massachusetts;
  2. Represent the field of medicine in which the alleged injury occurred;
  3. Practice medicine outside the county where the defendant physician practices or resides.

Contact Information Required:

To be included on the MMS tribunal list, complete the following form and hit the "Submit Form" button. 

All fields marked with * are required. 

First Name:*
   
Last Name:*
   
Your Specialty(ies):*  
   
County(ies) where you work/live:*




  (You can check multiple boxes)
   
   
Name of Your Practice:
   
Your Work/Practice address:
(Home address if retired)
Street:*


City:* 


State:* 


Zip Code:* 
   
Phone Number:*
   
Email:*
   
Are you an MMS Member?
(Not required to participate)
    
   
Videoconference Participation:
    
  If yes, what is your preferred location? 

    
   
Additional Comments:   

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