To have a lawyer review your concern fill
out the information and write a brief description of your oxycontin
related injury in the form below. This information will be kept
private and confidential and used for the sole purpose of evaluating
your case. Please note that without a phone number or e-mail
address we will not be able to contact you. Attorneys serve all
50 states. Please read
attorney client relationship.
Phone Number (day):
Phone Number (eve):
What is the Injured's relationship
Injured's Date of Birth?
Have you or they taken
How long was the medication
Are you still taking
Record from Doctor:
Did you experience withdrawal
symptoms or adverse side effects?:
What were the side effects?:
Did you attempt to stop
you or a loved one particpated in a drug rehabilitation program?