If you suffer from Osteonecrosis of the jaw (ONJ) or jaw death as a result of taking Fosamax you should contact an attorney. Please fill out the form below and your submission will be forwarded to an experienced attorney.
Free Fosamax Drug Details Consultation
Alternate Contact Person (not living in same household)
Title:
First Name:
Last Name:
Home Phone:
Cell Phone:
Work Phone:
Address:
City:
State, Zip:
Relationship to Injured:
Was the patient prescribed Fosamax?
Yes No
For what condition was Fosamax prescribed?
When did Fosamax therapy start?
*
When did Fosamax therapy end?
*
Please list name and address of doctor
who prescribed Fosamax:
What dental/jaw problems do you have?
What City/State did these occur in?
*
Please list name and address of doctor/dentist
who you have seen for these problems:
Has any doctor linked your
dental/jaw problems to Fosamax?
Yes No
If so, please list the name and address of doctor/dentist:
Case Description*
Please explain exactly what happened, trying to state
as thoroughly as possible who you believe was responsible
and why you believe that person was negligent:
Comments / Additional Information
Is there anything else that would assist us in
understanding the facts of your case?
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please tell us which search engine?
Please tell us exactly what terms you typed into the
search engine to find us? (i.e. Personal Injury Lawyers)
I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I understand that not all submissions may receive a response.
Yes
No
I agree that the above does not constitute a request for legal advice. I agree that any 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 t
