Risperdal Time is limited. Begin your FREE Review Today. Fill out the form below or call us toll free at 1-866-242-0905 Contact Information Fill out the following form or call 1-866-242-0905 24 hours a day, 7 days a week for a Free Case Review.   Contact Information First Name* Last Name   only one number is required Home Phone* - - Work Phone* - - Cell Phone* - - Email Address* Retype Email Address* Street Address: City State/Zip State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Injured Person's Contact Information The injured person is me spouse parent relative friend First Name: Last Name: Home Phone: - - Work Phone: - - Cell Phone: - - Email Address: Street Address: City: State/City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Date of Birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 20072006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Sex Male  Female   Risperdal Information When did the person start taking Risperdal? Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 20072006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 At what age did the person start taking Risperdal? Is there proof of taking Risperdal? Records from doctor? Yes No Pharmacy records? Yes No Prescription bottle? Yes No Why was Risperdal taken? pick one Schizophrenia Bi-Polar Disorder ADD Alzheimers Other Is Risperdal still being taken? Yes No While taking Risperdal was person diagnosed with any of the following? Neuroleptic Malignant Syndrome Yes No Stroke Yes No Stroke Like Events Yes No Blood Clot Yes No Hemorrhage Yes No Other Yes No If other, please describe: What was the approximate proximity to diagnosis and the drug being take? pick one Less than 24 hrs 24-48 hrs More than 48 hrs Do you or your injured person currentyl have an attorney representing you for your Risperdal Lasuit? Yes No Additional Comments:   a. leaving this box checked, I agree to receive future advertisements and announcements from our firm its affiliates and partners. b. I agree that submitting this form and the information contained within does not establish an attorney client relationship.. b. I agree that my information will be reviewed by more than one attorney and/or law firm. d. 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. Submit

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