Elidel & Protopic Cancer & Lymphoma Information

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WILLIS
LAW FIRM
1221 McKinney St.
One Houston Center
Suite # 3333
Houston,Tx 77010
TOLL FREE
1(800) 883-9858
1(800) 468-4878

*Disclaimer/Notice*

Nationwide Assistance for Victims of Elidel & Protopic Related Injuries

Elidel Lawsuit Evaluation & Protopic Lawsuit Evaluation

If you or a loved one have used Elidel or Protopic and you have been diagnosed with Cancer, Lymphoma, Tumors or other Immune System Disorders, then call us immediately to discuss your legal rights. The Willis Firm is currently investigating potential legal actions on behalf of a number of Elidel & Protopic users and their families. Mr. Willis is a Board Certified Personal Injury Trial Lawyer, certified by the Texas Board of Legal Specialization. For a Free Evaluation of your potential Elidel or Protopic Claim, please complete the following form and we will contact you promptly. This information will not be shared with anyone outside the Willis Law Firm and will remain confidential at all times. If you prefer, call us Toll Free at 1-800-883-9858

ELIDEL & PROTOPIC SIDE EFFECTS
FREE CASE EVALUATION FORM

Required Information Indicated by a RED ( * )

*Name :**
Address:
City:
State:
Zip:
*Email :**
*Phone :**	713-555-1212
Additional Phone :	713-555-1212
Cell Phone :	713-555-1212
Has the Elidel or Protopic user been treated for any type skin cancer, lymphoma, leukemia, tumors or suppressed immune system after using Elidel or Protopic ? *:

Did the Elidel or Protopic user have any medical history of cancer, tumors or lymphoma prior to the start of using Elidel or Protopic ? *:

*What is the current age of the Elidel or Protopic user ? :**	years old

*How many months have you or the family member used Elidel or Protopic ? :**	months

What was the date of the first medical diagnosis or treatment for any illness or condition that you believe may linked to the use of Elidel or Protopic ? *:	/ /

Comments:
I agree that submitting this form does not create an attorney client relationship.

If you prefer, call Toll Free 1-800-883-9858 or 1-800-468-4878