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Dangerous Drugs Consultation

Schedule a free legal consultation at Kerry Steigerwalt's Pacific Law Center if you believe that you or a loved one has been adversely affected by any of these dangerous drugs: Vioxx®, Accutane®, Bextra®, Zyprexa®, Paxil®, Celebrex®, Neurontin®, Crestor®. Please fill out the form below, providing as much information as possible to speed the processing of your inquiry.

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Injured Person Information

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If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased? Yes No
If deceased, the cause of death as stated on the death certificate:
Date of Death?
Was there an autopsy performed? Yes No N/A
 

Case Information

Which Drug were you prescribed?
During what period of time was Drug prescribed? Start End
Why was the Drug prescribed?
What daily dosage were you prescribed? (i.e. 25mg, 50mg, 75 mg)
List names/addresses of any doctors who prescribed the Drug:
 

Did effects from the Drug include:

Heart Attack Yes No
Stroke Yes No
Blood Clots Yes No
Deep Vein Thrombosis Yes No
Pulmonary Embolism Yes No
Death Yes No
Other medical problems since usage:
Other Information:
 

Disclaimers:

Yes No - I agree that by submitting this questionnaire, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.
Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.
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To learn more about dangerous drugs, please contact Kerry Steigerwalt's Pacific Law Center today about your case.

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Kerry Steigerwalt's Pacific Law Center - 1.800.508.0000