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

File a Claim Form
We have been working with families affected by these problems for a long time. If you have any questions, we will be more than happy to help you out. In addition, we will evaluate your claim at no charge. Any information you send through this form will be held in the strictest confidence and we will be sure to get back to you as soon as possible.

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Contact Information
* Name:
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Case Information

Are you contacting on behalf of someone else? If so who, and what relation to you.

Name:
Relationship:
* Have you or a family member taken Fentora®?
Yes
No
* Have you or a family member taken Actiq®?
Yes
No

* Have you or a family member used Fentanyl Transdermal Patches?

Yes
No
* Did the medication cause an overdose?
Yes
No
If so, what happened as a result of the overdose?
Untimely death
Coma
Other (Please describe below)

Please provide any information you have about a potential claim and ask any questions you have below. Any information you have regarding dates of drug use and dates of complications will be extremely helpful in determining the strength of your claim. If you do not recall exact dates, please leave your phone number and we will help you determine whether you are still able to make a valid claim.

Questions and Comments