Baycol Case Assessment

If you believe that you or someone close to you may have a personal injury or wrongful death claim, please fill out and submit the form below for a free evaluation.

There is no charge for this evaluation

First name:  
Last name:  
Phone :     (     )     -  


Injured Person Information:

Whom are you inquiring on behalf of?

If you are NOT inquiring on your own behalf, what is your relationship?

Is the person deceased? Yes No

If deceased, the cause of death as stated on the death certificate:  

Was there an autopsy performed? Yes No   n/a



During what period of time was Baycol taken?
Start End

List names/addresses of any doctors who prescribed Baycol:

Was Gemfibrozil (Lopid) taken while taking Baycol?
Yes No  

Were any other medications taken while taking Baycol?
Yes No  

If yes, please list any other medications taken while taking Baycol:

Has Rhabdomyolysis been diagnosed? Yes No  

Have any of the following problems occured while taking Baycol?

Muscle Pain Yes No  

Liver Problems Yes No  

Kidney Problems Yes No  

General Weakness Yes No  

Dark Urination? Yes No  

Malaise? Yes No  

Nausea Yes No  

Death Yes No  

Describe any other injuries or negative effects associated with Baycol use:

Other Information:

Yes No - I agree that this matter may be referred to an attorney in my area who may contact me.

Yes No - I agree that by submitting this question, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.

Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

By Clicking the appropriate box below, I agree to:
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