REQUEST MORE INFORMATION  

First Name:
Last Name:
E-mail:
Address:
City:
State:
Zipcode:
Phone:
Date of Birth:
Where was the drug prescribed?
 
Do you have proof of taking the drug from a prescription record, pharmacy record or record from a doctor?
Yes No
Please check all that apply to you:
Fosamax
Actonel
Didronel
 Zometa
Aredia
 Skelid
Boniva
When was the drug used?
Start Date:
End Date
Describe why bisphosphonate was prescribed:
Please check all that apply to you:
Cancer
Osteoperosis
 Hypercalcemia
Other
 Osteopenia
Have you been diagnosed with Esophageal Cancer?
Yes No
Date of Diagnosis:
Were dental procedures preformed at any time after you began taking the bisphosphonate?
Yes No
Please describe providing dates of each dental procedure (e.g. tooth extractions, caps, bridge work, etc).

When were the conditions requiring a dental procedure first identified?
Since taking bisphosphonate have you been diagnosed with osteonecrosis of the jaw?
Yes No
What was the date of diagnosis?
Since taking bisphosphonate have you been diagnosed with any other dental or jaw conditions?
Yes No
Which condition have you been diagnosed with? What was the date of diagnosis?
Has any doctor linked your jaw/dental problems to this drug?
Yes No
Do you currently have an attorney assisting you with this matter?
Yes No
Please describe your legal issues and needs:
Philadelphia Lawyers - Pennsylvania Lawsuits at Monheit Law

Law Offices of Michael Monheit 1368 Barrowdale Road  Rydal, PA  19046
Call Us Toll Free: 866-761-1385  P: 215-840-6573  E: Michael@Monheit.com

AddThis Social Bookmark Button View More Fosamax lawsuit Information
Home  |  Site Map  |  Fosamax Site Map  |  Blogs  |  Do I Have A Fosamax Case?

© 2002-2010 - Monheit Law, P.C. - Philadelphia PA Fosamax Law Firm. All rights reserved.
Location: 1368 Barrowdale Road, Jenkintown, PA 19046.  215-840-6573.

Personal Injury Attorney Disclaimer: This website provides general information about Pennsylvania Fosamax lawsuits and other legal information. Nothing on this site is intended to be legal advice. The materials on this site may be considered advertising. Nothing on this site constitutes the formation of an attorney client relationship. This website is not intended to solicit clients outside the State of New Jersey or the Commonwealth of Pennsylvania. In order to discuss representation, we must personally speak with you and enter into a signed, written agreement for representation. By utilizing this site, you agree to the foregoing.