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Free Ortho Evra Injury Case Review

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Contact Information

First Name
Last Name
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Email
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Street Address
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Case Information

Which type of Ortho Evra birth control did you use?
Patch
Pill
None
Were you or loved one injured as a result of using the Ortho Evra Birth Control Patch?
Yes
No
Did you or loved one suffer any of the following injuries?
Heart Attack
Stroke
Deep Vain Thrombosis (DVT)
Pulmonary Embolism (PE)
Blood Clots
Death
Other
Were you or loved on hospitalized due to your injury?
Yes
No
What proof do you or loved one have of using the Ortho Evra Birth Control Patch?
Pharmacy Records
Medical Records
Unused Patch
None
Did you or loved one smoke while using the Ortho Evra Birth Control Patch?
Yes
No
Do you or loved one currently have a lawyer or law firm representing you with an Ortho Evra Birth Control Patch claim or lawsuit?
Yes
No
Questions, comments, additional information

Disclaimers

I agree that submitting this form and the information contained within does not establish an attorney client relationship.
I agree that my information will be reviewed by more than one attorney and/or law firm.
I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

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