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Dilantin Side Effect

Stevens Johnson Syndrome

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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.

You will be contacted by an attorney or paralegal, who is experienced in the area of drug injury law.

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*Full Name of person needing assistance.
 *E-Mail
*Home phone
 Work phone
Cell phone
 Address
City, State, Zip
 Name of Medicine, Drug, or Over the
Counter medicine
What is best way to reach you?
(e-mail, phone, letter)
 *Injured in City, State
*Describe
*List all medication
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For Parents or Guardians

If the person in need of assistance is a minor or is a disabled adult with an appointed guardian we will need to communicate with that parent or guardian.