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* Name
Day Phone Number   
Evening Phone Number   
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The approximate dates on which you or your loved one began and ended Vioxx use:
The date or dates on which you or your loved one suffered an adverse reaction to Vioxx:
Myocardial infarction/heart attack? Yes   No
Sudden Death due to Heart Failure? Yes   No
Stroke? Yes   No
Transient Ischemic Attack [TIA]? Yes   No
Blood Clots? Yes   No
Other Cardiovascular Problem? Yes   No
Hypertension? Yes   No
Kidney or Liver Problems? Yes   No
Other suspected Vioxx Adverse Reaction
Provide any other information which you believe would be useful in analyzing yours or your loved ones adverse reaction or consequential damages.

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California Vioxx Lawyers, Free Consultation with California Vioxx Attorneys Northern California and Southern California

California Vioxx Lawyers Allis and Henke provide free consultations to those who suspect that they may have suffered adverse reactions from Vioxx use. Merely viewing the web site or contacting Mr. Henke by telephone or Accident Questionnaire, however, does not create an attorney-client relationship with Attorney Henke or Attorney Allis or their firms. The only way that an attorney-client relationship can be created with California Vioxx attorneys Henke and/or Allis or their respective firms is by a written attorney retainer agreement signed both by the client and by Mr. Henke. This web site is provided for informational purposes only. It is not intended as legal advice and should not be interpreted as legal advice, and in particular it should not be interpreted as legal advise with respect to whether you have or do not have a viable Vioxx claim.

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