Legal Help for Ortho Evra Patch Users

The Ortho Evra Online Information Resource

To get more information on the Ortho Evra Patch or to discuss your legal options please complete the following form. We will do our best to respond to your inquiry within 24 hours.

First Name:

Last Name:

Street Address:

Suite:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone:

Fax:

Email:

Best Time(s) to call:

Age:

How long did you use the patch ?

What was your injury?

Heart Attack	Deep Vein Thrombosis
Cardiac Arrest	Pulmonary Embolism
Stroke	Other

(check all that apply)

Were you still using the patch at the time of your injury ?

Yes No

Were you hospitalized as a result of your injury ?

Yes No

When did your Ortho Evra related injury occur?

Do you have any other information that you think would be helpful to us?

Submission of information for review does not create, is not intended to create, and must not be relied upon as creating, an attorney-client relationship. Such a relationship can only be created by the agreement of both the client and the attorney, evidenced by a written retainer agreement that has been signed by client and counter-signed by the attorney.

Contact Us if you took Ortho Evra Patch? and suffered from a heart attack or stroke