VIOXX LIABILITY FREE Vioxx Case Evaluation Please answer the following questions and fill out the Vioxx case form below. Question 1: Did you take Vioxx? When filing a claim, you should know when you started and stopped taking Vioxx, and what dosage you were taking.

Question 2: Did you take Vioxx regularly?

Users who took Vioxx regularly maintained a much higher level of Vioxx in their systems than those who took Vioxx only occasionally, and are therefore at a higher risk of stroke, heart attack, and other serious injuries.

Question 3: Did you suffer an injury after taking Vioxx?

In order for us to file a claim on your behalf, we need as much specific information as possible about your Vioxx-related injury. If you suffered a heart attack, stroke or other heart or circulatory problem that required hospitalization or surgery, you have a better chance of filing a successful claim. Please provide us with the type of injury (a stroke, heart attack, etc.), the exact date you were injured and whether you were taking Vioxx at the time.

If you answered 'yes' to all three questions, please fill out the Vioxx case form below. We will contact you to discuss your potential case. Please be sure to include a telephone number that you can be reached at during the day. If you have questions, please call us at (212) 732-6000 or email us at info@mccarthykelly.com

First Name:
Last Name:
Home Phone:
Work Phone:
Best time to call:
City and State:
Email:
When did you start Vioxx?
When did you stop Vioxx?
Did you take Vioxx daily or when needed?	Daily When needed
What was your dosage (mg)?
How many pills per day?
Did you experience any of the following:	Heart Attack Stroke Blood Clot Other
If other, please explain:
What were the dates of your Vioxx injury? (please be as specific as possible)
How did you hear about McCarthy & Kelly?	Alert Postcard Direct Mailing Existing Client Friend Newspaper Radio Referred by Attorney Search Engine TV Other
Additional Comments: