Levaquin / Cipro / Avelox Drug Injury Case Evaluation

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Case Facts

1. Have you, a family member, or some other person you know been diagnosed by a medical doctor with peripheral neuropathy or serious nerve damage while using or after using one or more of the drugs listed below:
YesNo

If Yes, which medical condition(s) was diagnosed by a medical doctor — can check one or both:

Peripheral Neuropathy

Serious Nerve Damage

If Yes, which drug(s) — can check one or more:

Levaquin

Cipro

Avelox

Levofloxacin (generic of Levaquin)

Ciprofloxacin (generic of Cipro)

Moxifloxacin (generic of Avelox)

2. Is this for you or someone else, and if it is for someone else, what is their relationship to you: MeSomeone Else

Relationship: 

3. What was the date of the initial diagnosis of the peripheral neuropathy or serious nerve damage: 

4. What is the date of birth of the person who had the peripheral neuropathy or serious nerve damage: 

5. Has a lawsuit been filed concerning the peripheral neuropathy or serious nerve damage:
YesNo

6. At the time of the peripheral neuropathy or serious nerve damage diagnosis, was the person using one of the drugs listed above: YesNo

7. If not taken at that time, when was the last time one of the drugs listed above was used prior to the peripheral neuropathy or serious nerve damage diagnosis:

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Please enter any additional information about this claim, as well as any comments or questions you may have, in the following space:

We handle all cases on a contingency fee basis, which means that you will make no payment for our legal services until after we have succeeded in getting legal compensation for you.

If you need immediate advice or legal representation for a possible personal injury or wrongful death claim, call us at our toll-free number: (800) 426-9535. Do not hesitate to contact us by phone, as there are no legal fees or any other costs incurred when you call us to speak about a possible case.

Please understand that if you are already represented by another lawyer, we cannot comment about nor evaluate your case. For this reason, we ask that you do not submit a Case Evaluation form to us if you have signed a contract of representation with another law firm.