Zyprexa Settlement

If you have developed diabetes, pancreatitis, hyperglycemia, ketoacidosis, extreme weight gain, diabetic coma, Neuroleptic Malignant Syndrome, or a family member has died from a diabetes induced heart attack or after committing suicide; we would like to speak with you. You may be entitled to participate in the nationwide Zyprexa settlement or to file an individual Zyprexa lawsuit to obtain compensation for your injuries or loss.

Free Zyprexa Case Evaluation

Please fill out the form below to have your case evaluated.

Please provide as much information as possible about your case. If you do not provide adequate case information, including injuries or damages sustained it may take us longer to process your inquiry.

*Items are required.
There is no charge for this evaluation.

Contact Information:
*Title: *First Name: MI: *Last Name:
 
*E-mail Address:
Home Phone:
 - -
Mobile Phone: - -
Work Phone: - - ext.
  *Provide at least 1 phone number.
*Street Address:
Apt/Suite:
*City:
*State/Zip: /
 
What is the best way to reach you?
Please provide the best place, time and method for contacting you.
 
Additional Contact Information:
Use this area to add country codes, foreign addresses, special instructions, etc.

Injured Person Information:
Date of Birth:
Whom are you inquiring on behalf of?
If you are NOT inquiring on your own behalf,
what is your relationship?
Injured person height
Injured person weight

Case Information:

During what period of time was Zyprexa prescribed?
Start End

Why was Zyprexa prescribed?

What dosage of Zyprexa were you prescribed daily? (i.e. 25mg, 50mg, 75mg)

List names/addresses of any doctors who prescribed Zyprexa:

Did you develop diabetes while on Zyprexa? Yes No
Date diagnosed with diabetes
Where were you hospitalized/treated for this?
Do you smoke cigarettes Yes No
Are you dependent on insulin? Yes No
How often to you take insulin?
What method of taking insulin do you use?
Do you have a relative with diabetes Yes No
Please indicate the amount of physical activity you engage in:
Do you have a history of any of the following? Gestational diabetes Vascular disease
Dyslipidemia Polyeystic ovary syndrome
Schizophrenia Hypertension
What is your race/ethnicity

Please list the names, addresses, phone and fax numbers of the pharmacy/pharmacies you purchased Zyprexa from:

How did you hear about us?

Other Information:
 

Disclaimers:

Yes No - I agree that this matter may be referred to an attorney in my area who may contact me.

Yes No - I agree that by submitting this question, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.

Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. 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.

"Disregard this solicitation if you have already engaged a lawyer in connection with the legal matter referred to in this solicitation.  You may with to consult your lawyer or another lawyer instead of us.  The exact nature of your legal situation will depend on many facts not known to us at this time.  You should understand that the advice and information in this solicitation is general and that your own situation may vary.  This statement is required by rule of the Supreme Court of Missouri."

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