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2015
October
H
Health care Medication side effect survey Nation w
Health care Medication side effect survey Nation w
0%
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First Name
Last Name
Address
City
State
Zip
Phone
Mobile
Email
Which Medicine you use or Surgery you had done?
Mesh Surgery
Bladder Sling Surgery
Xarelto Blood thinner
Testosterone Therapy (Low-T)
IVC (inferior vena cava filters)
Invokana
Benicar
Anti depressant
Zofran
Lung Cancer
Power Morcellators
Other
Have you faced any side effects or complications?
Yes
No
Describe your side effects / complications or comments in the box.
Are you currently represented by an Attorney or LawFirm regarding this Matter?
Yes
No
Would you be interested in speaking with an Attorney for a free case review?
Yes
No
Best Time to contact
Morning
Afternoon
Evening
Anytime
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