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Ortho Evra Questionnaire

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Ortho Evra Questionnaire: Have you experienced a serious side effect related to the use of the Ortho Evra Patch?

If you've suffered a serious side effect such as a heart attack or stroke while using the Ortho Evra birth control patch, complete this simple questionnaire for a FREE evaluation of your possible Ortho Evra lawsuit. Your case will be reviewed within 24 hours and your information will be kept strictly confidential.

Now you can receive important updated information on the risks of using the Ortho Evra Birth Control Patch. Request a complimentary information booklet (supplies are limited).

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Please complete the following questionnaire:

Name
Email
Phone Number
Best time to call
Did you use the Ortho Evra Birth Control Patch?yes
no
How long have you used the patch?
Have you experienced any of the following? blood clot
heart attack
stroke
pulmonary embolism
other
internal blood clot
menstrual clotting
If other, please describe
Do you smoke?yes
no
Additional comments/questions:


see also:

Updated FDA Warnings FDA Continues to Update Warnings to Label of Ortho Evra--attorney info
Read on for information regarding Updated FDA Warnings to Ortho Evra

Research Center Have you experienced harmful side effects from the Ortho Evra patch?
Get information on the dangers of using Ortho Evra birth control patch

Ortho Evra Risked your health taking Ortho Evra? Lawsuit Information from W & L
Did Ortho Evra put your health at risk? Find out about a lawsuit here.
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