HermanGerel - Product Liability Contact Form

Do I Have a Case?

PRODUCT LIABILITY

Please complete the form below to briefly explain your situation.

We will review your information and contact you as soon as possible. Thank you for choosing HermanGerel.

PRODUCT LIABILITY We value your privacy.
	Contact Information
* First Name
* Last Name
* Email
* Phone
Street
Street Cont.
City
State/Province		Zip

	Injury Information
Nature of injury
What medications were you taking that you suspect caused your injuries?
Where did you buy the medication?
When did you first take the medication?
When did you last take the medication?
When were you diagnosed with an injury?
Where were you diagnosed?
By whom were you diagnosed?
Who referred you to us?

	Closest living relative
Name
Address
Phone


* Please add any additional information that you would like us to consider.

*	indicates a required field
The transmission of an email inquiry does not create an attorney-client relationship. HermanGerel will only act as your counsel in any matter if you and our firm expressly agree in writing that we will serve as your attorney. There are Statutes of Limitations that vary from state to state that limit the time period within which you may assert certain claims or file certain lawsuits. If you think you might have a potential claim, please contact a lawyer as soon as possible to protect your rights.