Submit Your Lamisil Inquiry Case: If you or a family member has been injured by using Lamisil submit your inquiry to our attorneys for a free evaluation of your situation.

We represent seriously injured people throughout the country and foreign nationals injured in the United States.
Please read our disclaimer and terms of use.


Title:

First Name:

  M. I.

  

 Last Name:

 Address:

 City:

 State:

 Zip Code:

 Phone Number (day):

 Phone Number (eve):

Email Address 

 If this inquiry is not for yourself, please tell us the name of the person?:

Title:

First Name:

M. I.

Last Name:

What is the Injured's relationship to you?:

Injured's date of birth? (mm/dd/yyyy) 

 Have you or they taken Lamisil?:

 Yes No

Dates of use?:
Do you have proof of taking Lamisil from: 

 Prescription Bottle:

 Yes No

 Pharmacy Records:

 Yes No

 Record from Doctor:

 Yes No

Have you or they been diagnosed with liver complications?: 

 Yes No
 Have you or they been diagnosed with liver failure? Yes  No

Date of Diagnosis?:
 What other side effects have you or they experienced?

Please briefly describe your legal concern
 
 I understand that submitting this form does not create an attorney client relationship: Agree


Submit by pressing button below