If you would like more information on pursuing a
claim for damages due to PPA (Phenylpropanolamine),
please fill out the form below.
There is no charge for this evaluation.
* Required Fields.
**
Click on the "Disclaimer" link below for Terms
Title*:
First Name*:
MI
Last Name*:
E-mail Address*:
(ex. johndoe@anywhere.com)
Home Phone*:
(ex. 505-555-5005)
Work Phone:
(ex. 505-555-5005)
Mobile Phone:
(ex. 505-555-5005)
Street Address:
City:
State / Zip:
/
(ex. NY / 10005)
Drug Information
In what
state was
the drug prescribed?
What date
did you start taking the drug?
What date did you stop taking the drug?
What dosage were you prescribed?
When did you have a stroke?
When was the last time before your stroke that you
took PPA?
What is the name (including brand name), dosage, and
how frequently you took the medicine:
List all other medications you were taking when you
took PPA:
Please
describe circumstances involving your stroke:
List any
other problems you developed while taking PPA:
Did a
doctor ever tell you that you were injured as a result
of taking PPA:
Yes
No
If so,
when:
Additional Information
Do you currently have an attorney who represents you on behalf
of your PPA claim?
Yes
No
Personal Injury Attorney Disclaimer: This website provides general information about Pennsylvania PPA 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.
