Neurontin Lawyer > Neurontin Case Review

Please fill out the form below if you or a loved one has been affected by Neurontin and desire legal assistance. The form should take no longer than 3-5 minutes to complete.

Personal Information

Name of Injured Person:

E-mail Address:

Phone:

Street Address:

City/State/Zip:

State: Zip:

County of Residence:

Date of Birth:

Social Security Number:

Name of Spouse:

Name of Reporter (if injured person is unable to respond):

Your relationship to the injured:

Contact Person in Case of Emergency

Name:

E-mail Address:

Phone:

Address:

Have you contacted another attorney? (If so, whom)

Neurontin-Related Information

Date you began taking Neurontin:

Date stopped:

Dosage:

For what medical condition were you prescribed Neurontin?

Bi-polar disorder

Peripheral neuropathy

Diabetic neuropathy

Trigeminal neuralgia

Post-Herpetic neuralgia

Essential tumor

Migraine

Drug or alcohol withdrawal seizures

Periodic limb movement disorder

Restless Leg Syndrome (RLS)

Attention Deficit Disorder (ADD)

Amyotrophic lateral sclerosis (ALS)

Other

While taking Neurontin, did you or your relative experience any of the following events:

Suicide (if yes, please provide Death Certificate)
Attempted Suicide

Were you hospitalized as result of any attempted suicide? If so, for how long?

Yes

Length of Hospitalization:

While using Neurontin, did you or your loved one experience any of the following conditions?

Depression

Suicidal thoughts

Paranoia

Indifference

Delusions

Apathy

Fatigue

Withdrawal

Thoughts of death or dying

Decision-making failures

Mania Precipitation

Hostility

Sedation, Oversedation

Greater Rapid Cycling

Dizziness

Headaches

Muscle weakness, cramping

Anxiety

Amnesia

Depressed Appetite

Abnormal eye movements

Mania

Difficulties/Changes in Personal Life

Difficulties/Changes in Employment

Before taking Neurontin:

Ever attempt suicide? If yes, date?

Ever have suicidal thoughts?

Yes

If you or a loved one has used Neurontin for purposes other than its FDA-approved use, please call an experienced Neurontin lawyer at VanDerGinst Law, P.C. by calling (866) 843-7367 or submit a free online case evaluation. The initial consultation is free of charge. If we agree to handle your injury case, we will work on a contingency fee basis, meaning we are paid for our services only if, and when, there is a money recovery for you. In many cases a lawsuit must be filed before an applicable expiration date known as a statute of limitations. Please call our office right away to ensure you do not waive your right to possible compensation by consulting a Neurontin lawyer.

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