Serzone Free Consultation Form

Serzone

Do I have a Case?

Don't delay any longer.

Protect your rights - and your health. Contact our Serzone lawyers for a free consultation.

Serzone victims just like you are protecting their rights! Learn if you have a Serzone class action lawsuit now.

It's easy to get started. Simply fill out our Serzone Fight Back form for your free Serzone consultation. We'll help you understand your potential Serzone lawsuit rights, listen to your needs and explain the Serzone litigation and class action process. Most importantly, a Serzone lawyer will tell you if we believe you have a Serzone lawsuit and how you can take action, now.

There's no obligation, and no sales pitch. Just helpful Serzone advice from a knowledgeable Serzone lawyer. Fill out the Serzone Fight Back form to find out if you have a Serzone lawsuit!

Do I have a Serzone Case?
First Name:
Last Name:
*E-mail:**		(ex. johndoe@anywhere.com)
Day *Phone:**		(ex. 505-555-5005)
Alt. Phone:		(ex. 505-555-5005)
Address:
City:
State / Zip:	/	(ex. NY / 10005)
Additional Contact Information: Opt. country code, special instructions, etc.

Injured Person Information:
Date of Birth:
Whom are you inquiring on behalf of?
Is the person deceased?		Yes No
If deceased, the cause of death as stated on the death certificate:
If deceased, date of death:
If deceased, was there an autopsy performed?		Yes No

Case Information:
During what period of time was Serzone taken? Start End List names/addresses of any doctors who prescribed Serzone:
Were any other medications taken while taking Serzone?		Yes No
If yes, please list any other medications taken while taking Serzone:

Have liver problems occurred since taking Serzone?		Yes No
If yes, please describe liver problems:

Have you had a Liver Function Test (LFT) since taking Serzone?		Yes No
If yes were the LFT enzymes elevated?		Yes No
If yes, what were the results of liver enzyme tests?

Have liver problems been diagnosed by doctor?		Yes No
If yes, what was the diagnosis?

Did suicidal thoughts occur while taking Serzone		Yes No
If yes, was Suicide attempted		Yes No
Describe any other injuries or negative effects associated with Serzone use:

Other Information:

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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

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