Skip to content

Call Us Today! 1.833.633.7847|info@oddrugs.com

Facebook LinkedIn

Search for:

Home
About
Our Focus
Questionnaire
Contact

Home
Questionnaire
About
John Larson
Jim Magazine
Elizabeth Magazine
Jeff Lucas
Terms Of Use
Contact

Opioid Overdose QuestionnaireChris2019-01-30T00:32:14-05:00

Opioid Overdose Questionnaire

Please Take A Moment To Fill Out This Questionnaire

Name Of Decedent*
First Last
Contact's Name*
First Last
Primary Phone*
Secondary Phone
Email*
Enter Email Confirm Email
Relationship To Decedent*
Date Of Death*
Date Format: MM slash DD slash YYYY

**There Is A 2 Year Statute Of Limitations. If It's Past 2 Years We Have No Case
Do You Have The Autopsy Report*
- Yes
- No
- Unknown
**If Not It Will Need To Be Obtained
Was Decedent On Prescription Opioids?*
- Yes
- No
If So, Do You Know What He/She Were Taking And How Long?*
- Yes
- No
- Unsure
Please List The Opioids (If Known) And Amount Of Time Taken:
Do You Know Who Prescribed And What Was The Reason They Were Prescribed?*
- Yes
- No
- Unknown
Please Provide Name(s) And Reason(s):
Do You Know The Pharmacy (Or Pharmacies) That Decedent Obtained Their Prescriptions From?*
- Yes
- No
Name(s) Of Pharmacy:*
Once We Get The Autopsy Report That Will Have The Toxicology On It, We Can Determine The Validity Of The Case. To Expedite The Process, Please Obtain A Copy Of The Autopsy Report From The Coroner.

Don’t Wait Any Longer

We Are Here To Help

833-OD-DRUGS
(833-633-7847)

THERE IS NO FEE UNLESS WE RECOVER

THERE ARE NO OUT OF POCKET COSTS FOR YOU
WE WORK ON A CONTINGENCY FEE BASIS

Our Attorneys

John Larson, Esq.

John Larson, Esq.Attorney

Licensed in Illinois
Read More…

Jim Magazine, Esq.

Jim Magazine, Esq.Attorney

Licensed only in Florida
Read More…

Elizabeth Magazine, Esq.

Elizabeth Magazine, Esq.Attorney

Licensed in Illinois, Of Counsel
Read More…

Overdose Questionnaire
Terms Of Use
Contact

© Copyright 2012 - | Larson Magazine Law Offices | All Rights Reserved
Site by CICOR Marketing

Facebook LinkedIn