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Name of the Pondimin/Redux User:*

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Age*

Did you take Pondimin or Redux?*

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

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

Describe your current heart and lung medical condition*

Have you already received any compensation for a Fen Phen Injury? If yes, approximately when was it received?*

Approximately how much gross compensation - before reduction for attorney fees and costs - have you already been awarded for your Fen Phen injury?*

None

$500 or less

$2,000

$6,000

$8,000

Matrix Compensation less than $400,000

Matrix Compensation more than $400,000

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Did you file a form opting out of the Seventh Amendment Settlement by November 2004?

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Cynthia K. Garrett, Attorney at Law

7136 S. Yale Avenue, Suite 300

Tulsa, Oklahoma 74136

Toll Free Telephone: (866) 584-0070

Email: ckg@ckglawfirm.com

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Delivery of information through this website does not constitute legal advice.

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