Perscription Medication Lawsuit Claims

No Fee, unless we collect on your behalf

Claim Evaluation Form

Fields marked with an * are required.

* Name

Address

City

State

Zip Code

* Phone

Phone 2

Best Time to Call

Email Address

Side Effects

	Heart Attack
	Heart Failure
	Stroke
	No know side effects to date

How long were you or a loved one on the medication?:

	Less than one year
	More than one year
	Don't know

* What health effects have you suffered?
When did they take place?
Comment on any medication use?

I agree that the above is not a request for legal advice and that I am not forming an attorney client relationship. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.