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Did you take Pondimin or Redux? If yes, for how long?*

Have you been diagnosed with aortic or mitral valve regurgitation (leaking valve)? If yes, when?*

Have you had aortic or mitral valve repair or replacement surgery? If yes, when?*

Have you been diagnosed with pulmonary hypertension? If yes, when?*

How much compensation for your Fen-Phen injury have you already received*

Describe your current heart and lung medical condition.*

If Fen-Phen User is deceased, give date of death, age at death, your name & relationship to the deceased.

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If you are completing this form for another person, answer the questions as to the Pondimin/Redux User, and then give your name at the bottom of the form.

Cynthia K. Garrett, Attorney at Law

7136 South Yale Avenue, Tulsa, Oklahoma 74136

Toll Free: 866-584-0070 Email: ckg@ckglawfirm.com

Request a Free Initial Case Review

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​​INSTRUCTIONS FOR COMPLETING CONTACT FORM:

Cynthia K. Garrett, Attorney at Law

INSTRUCTIONS FOR COMPLETING CONTACT FORM: