Free case evaluation

ZyPrexa case evaluation form

HendlerLaw is reviewing cases of individuals who have suffered diabetes or other serious side effects while taking ZyPrexa. Our case evaluation is free of charge and you are not responsible for any legal fees unless we obtain compensation for you.

Please fill in the form below and we will get back to you shortly to conduct your case evaluation.

* Fields Required

* First Name
* Last Name
Address Line 1
Address Line 2
City
State
Zip Code
* Phone
* Best Time to Reach by Phone?
* E-Mail

Tell Us about Your ZyPrexa Experience

* Who Has Taken ZyPrexa? Yourself  Relative
* Date of Birth of Person Taking ZyPrexa
  DD/MM/YYYY
* When did you begin using ZyPrexa?
  MM/YYYY or Not Sure
When did you stop using ZyPrexa?
  MM/YYYY or Still Taking
Why were you prescribed ZyPrexa?
* What side effect have you developed?  diabetes
 diabetic coma
 diabetic ketoacidosis
 pancreatitis
 hyperglycemia
 other:
When were you diagnosed with this side effect?
MM/YYYY
* Is there a history of diabetes in your family? Yes  No
* Do you have a history of any of the following?  hyperglycemia
 childhood diabetes
 acute pancreatitis
 alcoholism
 obesity
 none of the above

*Please be aware that by completing this form you are not retaining the legal services of a law firm. The information requested in the form is needed for an attorney to contact you to begin evaluating your case. Additional information will be required to complete your case evaluation and pursue a legal claim.

Please contact us if you have questions or need more information. HendlerLaw represents individuals with a range of toxic illnesses. Call us 24 hours a day at 1-800-443-6353 or e-mail us at help@hendlerlaw.com.

 

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