Overview FAQs Health Risks AHP Settlement To locate an attorney to evaluate your case, choose from a practice area below: Select an Area Business Law ------------------- Bankruptcy Business Law Contract Law Copyright Law Foreclosure Franchise Law Insurance Law International Law Mediation Mergers/Acquisitions Partnerships Patent Law Real Estate Law Trademark Law Consumer Law ------------------- Consumer Fraud Consumer Protection Debt Consolidation Lemon Law Unfair Debt Collection Unfair Trade Practice Criminal Defense ------------------- Criminal Defense Driving Violations Discrimination ------------------- Age Discrimination Civil Rights Disabilities Racial Discrimination Sex Discrimination Sexual Harassment Drug Litigation ------------------- Baycol Bextra Ephedra Fen Phen HRT PPA Rezulin Vioxx Employment Law ------------------- Employee Benefits ERISA Claims Retirement_Plans Whistle Blower Workers Comp Wrongful Discharge Estate Law ------------------- Elder Law Estate Planning Probate Admin Trusts Will Contests Family Law ------------------- Child Custody Child Support Divorce Law Government ------------------- Civil Litigation Immigration Law Military Law Health Law ------------------- Defective Hip Joints Lasik Litigation Medical Malpractice Nursing Homes Personal Injury ------------------- Brain Injury Car Accident Motorcycle Accident Personal Injury Trucking Accident Wrongful Death Stocks & Securities ------------------- Churning Investor Fraud Securities Fraud Unauthorized Trading Taxes ------------------- Tax Liens Tax Levies Tax Preparation Unpaid Taxes Toxic Products ------------------- Asbestos Lead Paint Mesothelioma Toxic Mold Welding Rods Transportation ------------------- Airplane Aciidents Admiralty Law Railroad Law Fen-Phen Free Case Evaluation Bella Vista, Arkansas Lawyers Please complete the form below to contact a Fen-Phen Lawyer in Bella Vista, Arkansas. Be sure to complete all fields in full and be as descriptive as possible about your case so that we can be as thorough as possible with our free case evaluation. First Name: Last Name: Street Address: Suite: City: State: ALAKARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code: Home Phone: Work Phone: Cell Phone: Fax: Email: Are you currently represented by counsel in a Fen-phen claim? Yes No Do you have a Pending Green Form Claim with the AHP Settlement Trust? Yes No If so, which Level of Matrix compensation did you claim on your Green Form? Level 1 Level 2 Level 3 Level 4 Level 5 Dont Know Indicate which of the following you have or have received: A copy of my Pink or Blue Form A copy of my Green Form My Diet Drug Claim Number $6,000 or $3,000 from the Settlement Matrix Level Compensation Payment Reimbursement for Cost of Diet Drugs Free Screening Program Echocardiogram Are you timely registered with the Fen-phen Settlement? Yes No Was your claim for Matrix Level compensation denied? Yes No Did you Opt-Out of the 7th Amendment? Yes No Has your doctor recommended surgery to repair or replace your diseased valve? No Surgery is Required Yes, I have already had the surgery Yes, the surgery has been scheduled Yes, but I am not a good candidate for surgery Yes, but my doctor advised me to wait Yes, my doctor thinks I may need a heart transplant Check all of the following that apply: I was diagnosed with Primary Pulmonary Hypertension (PPH) I have undergone a Cardiac Catheterization I have undergone a Lung Scan I took or am currently taking Flolan Have you ever been diagnosed with any of these additional conditions? Unsure Bacterial Endocarditis Pulmonary Hypertension Arrythimia Atrial Fibrilation Atrial Enlargement Do you have any other information about Fen-Phen or your experience with the drug that you believe may be helpful for us to know? Please tell us more about yourself and your situation including: Your Age, Current line of Work Do you have your Fen-phen prescription records? When was your last echocardiogram? Do you have a copy of your echocardiogram report / videotape? Do you have a Diet Drug Claim Number? Did you file a Green Form? When? Do you have a copy? What Level of compensation did you apply for? Has your claim been audited or denied? Have you received any money for the Settlement? When is the best time to contact you?

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