File a Claim Form

fentanyl lawsuits We have been working with families affected by these problems for a long time. If you have any questions, we will be more than happy to help you out. In addition, we will evaluate your claim at no charge. Any information you send through this form will be held in the strictest confidence and we will be sure to get back to you as soon as possible.

Name *

Phone

E-mail *

Have you or a family member taken either the Duragesic Pain Patch or Actiq lolipop? *

Yes
No

Did the fentanyl medication cause an overdose? *

Yes
No

If so, what happened as a result of the overdose?

Untimely death
Coma
Other (Please describe below)

Please provide any information you have about a potential claim and ask any questions you have below. Any information you have regarding dates of drug use and dates of complications will be extremely helpful in determining the strength of your claim. If you do not recall exact dates, please leave your phone number and we will help you determine whether you are still able to make a valid claim.

Questions and Comments


*indicates a required field

 

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