If you have concerns about taking VIOXX, please complete the form below and we will review your information and contact you with details. Required Fields are marked with a blue dot, and all YES or NO questions must be answered.

Required Information
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip:
Phone (include area code):
Work Phone (include area code):
Other Phone (family, pager, cellular):
Email Address:
Date of Birth (mm/dd/yyyy):

VIOXX SPECIFIC QUESTIONS: Please answer below.
Have you ever taken Vioxx?   YES      NO 
If you answered YES, explain for what medical condition Vioxx was prescribed.
What dosage of Vioxx were you taking (12.5 mg, 25 mg, 50 mg), and how frequently were you taking this dosage?
When did you start taking the drug? (mm/dd/yy)
When did you stop taking the drug? (mm/dd/yy)

Has the use of VIOXX resulted in a death?   YES      NO 
If you answered YES, What is the name of the deceased?
What is your relationship to the deceased?
What caused their death and when?

Have you ever had any of the following symptoms or medical conditions during the time that you were taking Vioxx or within a week after you stopped taking the drug? You must answer YES or NO to all questions.
1. Stroke:  YES    NO
  When:
2. Heart Attack:  YES    NO
  When:
3. Other Vioxx related side effects:  YES    NO
  Please describe any side effects in detail below:

Have you already retained an attorney for this case?   YES      NO 
If YES, provide the complete name, address and telephone for the attorney.

How did you hear about our lawfirm? (please be specific)

The information contained in this website is for informational purposes only and is not intended to be legal advice. The attorney-client relationship can only be formed by written agreement of the parties. All trademarks are the property of their owners. Sanford Stevenson Riff LLP are not affiliated with the manufacturers of Vioxx or Bextra, nor is this website affiliated, sponsored, or endorsed by Merck or Pfizer. The attorneys of Sanford Stevenson Riff LLP are licensed to practice law only in the State of Texas. Other lawyers likely to be associated with the handling of these claims.