Viagra Melanoma Lawsuit

Houston

3200 Travis : 3rd Floor
Houston, TX 77006
(713) 529-0025
(713) 751-0412 (fax)

Galveston

(409) 762-9090

Toll Free

888-529-4688

andrewsteinberg@lawyer.com
www.thesteinberglawfirm.com

Viagra Melanoma

Free Case Review

Fill out the form below if you need additional information or want to discuss a potential claim with an attorney. All inquiries are kept strictly confidential.

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Contact Information
* Title:
* First Name:
* Last Name:
* Relationship to Viagra user:
* Email Address:
* Phone:
* Phone (Cell):
* Address:
* City:
* State:
* Zip:

How would you prefer to be contacted?

Email Mail Phone
Case Information
Name of Viagra patient:
Date of birth of Viagra patient (mm/dd/yyyy):
Age of patient when Viagra was prescribed:

Did you or a loved one suffer from any of the following caused by Viagra?

diagnosed with melanoma
death

Were you or a loved one on Viagra at the time?
Yes
No

If no, how long have you or a loved one been off Viagra?

Were you or a loved one hospitalized for these problems?
Yes
No
Was medical care required after using Viagra?
Yes
No

Were you on Viagra at the time of medical care?
Yes
No
When did this occur?