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

Free Case Review
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Contact Information
* Title:
* Name:
* Relationship to Yaz®/Yasmin® User :
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Case Information

Name of Yaz®/Yasmin® User
Age of Yaz®/Yasmin® User

When was Yaz® prescribed?
What medical condition(s) was the Yaz® prescribed for?
Did you take Yaz®, Yasmin® or other?
Did you or loved one suffer any of the following while using Yasmin®?
Dizziness
Ringing in the Ears
Changes in Vision
Headaches
Forgetfulness
Depression
Were you on Yaz® or Yasmin® at the time symptoms occurred?
Please describe in detail other Pseudotumor Cerebri related problems / injuries you believe may be associated with taking birth control such as Yaz®?