Fosamax, Actonel, Zometa Aredia Class Action Defective Drug Lawyers

If you will complete this form as best you can, Mr. Mitzner will personally review your contact information to determine if you have a claim for monetary damages for the drugs you have been prescribed. After Mr. Mitzner has reviewed your contact information, he will personally contact you within 48 hours to personally discuss the information you submitted and to obtain more information.

You will be under no obligation and your interview, along with any legal advice you are given, will be provided absolutely without cost. Your legal options will be explained to you. You will have the choice of what to do. You will not be pressured. Your information will be treated completely confidential and will not be referred to anyone. You will have complete control over the next step, if any, that is taken.

DO YOU HAVE A CASE?? CONTACT US FOR A FREE CASE REVIEW

Contact Information
First Name
Last Name
Home Phone
Work Phone
Cell Phone
Email
Confirm Email
Street Address
City
State
Zip

Case Information
Which drug was taken?
Start Date
Stop Date
When was the drug prescribed?
Name of doctor or treating physician
Is the drug still being taken?	Yes No
While taking the drug were you taking any additional drugs or medications?	Yes No
Please list other medications
Did the injured person have dental work or surgery while using Fosamax, Aredia or Zometa?	Yes No
Did the injured person experience pain or soreness in the jaw?	Yes No
Has the injured person been diagnosed with Osteonecrosis of the Jaw (ONJ)/Dead Jaw?	Yes No
Date of injury
Have you been contacted by an attorney or law firm about your potential case?	Yes No
What was the attorneys or lawfirm name?
When were you contacted?
Questions, comments, additional information
Disclaimers
By leaving this box checked, I agree to receive future advertisements and announcements from our firm its affiliates and partners.
I agree that submitting this form and the information contained within does not establish an attorney client relationship.
I agree that my information will be reviewed by more than one attorney and/or law firm.
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.