Drug Injury Law Information
Law Offices of Thomas J. Lamb, P.A.


PRESCRIPTION DRUG INJURY CASE EVALUATION

Our law firm represents people in personal injury and wrongful death cases that involve serious side effects or serious reactions caused by an unsafe drug or recalled drug, as well as adverse drug events and adverse drug reactions resulting from a drug-drug interaction or a medication error.

Personal Information

*Required Fields
*Your Name: *E-mail:
Street Address: City:
State: Zip:
*Phone Number: Best time to call: DayNight

Personal Injury Case Facts

1. Has a doctor said that you have a medical condition or disease caused by one or more prescription drugs? YesNo
If yes, please indicate which condition(s) or disease(s) the doctor diagnosed; check all that apply:
Liver Failure Liver Injury
Liver Disease Drug-Induced Hepatitis
Acute Renal Failure Kidney Failure
Kidney Injury Rhabdomyolysis
Stroke (Cardiovascular Accident or CVA) Heart Attack
Heart Failure Heart Valve Damage
Organ Transplant Other
2. What was the date of the initial diagnosis:
3. What is your date of birth:
4. Have you filed a lawsuit concerning your drug-related condition or disease?YesNo
5. Please list below the prescription drug(s), followed by dosage information (example: 10 mg pill 2 times per day), that you were taking just before the onset of the drug-related condition or disease:

Wrongful Death Case Facts

1. Was a drug-related condition or disease possibly involved with the death of a family member or someone else you know?YesNo
If yes, please indicate which condition(s) or disease(s) the doctor diagnosed before or at the time of death; check all that apply:
Liver Failure Liver Injury
Liver Disease Drug-Induced Hepatitis
Acute Renal Failure Kidney Failure
Kidney Injury Rhabdomyolysis
Stroke (Cardiovascular Accident or CVA) Heart Attack
Heart Failure Heart Valve Damage
Organ Transplant Other
2. What was the date of the initial diagnosis:
3. Have you or someone else filed a lawsuit concerning this death?YesNo
4. What was the date of death?
5. Please list below the prescription drug(s), followed by dosage information (example: 10 mg pill 2 times per day), that you were taking just before the onset of the drug-related condition or disease:

Is there any additional information you would like to include?

Please enter any additional information about this claim, as well as any comments or questions you may have, in the following space:

About Your Case Evaluation

As always, if you need immediate advice or legal representation for a possible claim involving any of our practice areas, call us on our toll-free number: (800) 426-9535. Please do not hesitate to contact us, as there are no legal fees or any other costs incurred whether you fill out our case evaluation form or call our office to speak about a possible case.

If you do not receive a response from us within 72 hours from the time you submit your evaluation form or your matter is urgent, please call us on our toll-free number: (800) 426-9535.

If you are already represented by an attorney, we cannot speak with you or provide you with any legal advice without the consent of your attorney. Accordingly, if you are already represented by an attorney, please do not contact us or submit this evaluation form without your current attorney's knowledge and consent.

Confidentiality Statement and Disclaimer

All information provided to us by means of this evaluation form will be treated by the Law Offices of Thomas J. Lamb, P.A. as strictly confidential. Please note that your submission of a case evaluation form is not intended to create, and receipt does not constitute, an attorney-client relationship between you and the Law Offices of Thomas J. Lamb, P.A.

Furthermore, by providing this free case evaluation service, the Law Offices of Thomas J. Lamb, P.A. does not seek to represent anyone in a state where this site may fail to comply with all laws and ethical rules.



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Law Offices of Thomas J. Lamb, P.A.
Lumina Station Suite 225
1908 Eastwood Road
Wilmington, NC 28403
Tel: (910) 256-2971    Fax: (910) 256-2972
Toll Free: (800) 426-9535
e-mail: Info@DrugInjuryLaw.com

Copyright © 2003 Law Offices of Thomas J. Lamb, P.A.
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