Have you hired an attorney to represent you on your Xarelto claim?
What date was Xarelto first prescribed?
Have you stopped taking the drug Xarelto? What date did you stop taking Xarelto?
What injury occurred as a result of you taking the drug Xarelto?
What date did this injury occur?
Were you taking Xarelto when this injury occurred?
At the time of injury, were you taking the brand orgeneric version of Xarelto?
Were you hospitalized because of your Xarelto related injury?
Why were you originally prescribed Xarelto?
What is the name of the prescribing Doctor/Provider?
What pharmacy was your Xarelto prescription filled?
Have you ever had a stent placed inside of you?
Were you taking Aspirin at the same time your Xarelto related injury occurred?
Were you taking any other blood thinner or anticoagulant while you were on Xarelto?
Please list all other medications you were prescribed and taking while you were on Xarelto?
Please list all doctors who treated you during time ofinjury?
Are you contacting us about a deceased person injured while using Xarelto?
Do you have any additional notes to add, or anything youwish to share that we did not cover?
Have you ever received any government benefits? Including anything you may currently receive.
Have you ever filed Bankruptcy?
Do you currently use any social media, like Facebook or Twitter?
What is your date of birth?
Should be Empty: