mctlaw Privacy Policy Contact Us Now Name* First NameLast Name Email* Phone Number Please enter a valid phone number. Areas of Practice* Please Select Vaccine Injury Metal on Metal Hip Replacements Ozempic, Trulicity, Mounjaro, Wegovy, Rybelsus, Zepbound Depo-Provera Kratom Lawsuits Food Recall Indian Law Federal Takings/Eviction Moratorium Rails to Trails Inspire Sleep Apnea Recall Other Choose a legal area that best fits your needs Back Next Is This About a COVID-19 Vaccine Injury?* Please Select.. YES NO Did you get any of these vaccinations in the 45 days before or after the COVID-19 shot? Flu, Tetanus, Pneumonia, Measles, Mumps, Rubella, MMR, Chickenpox/Varicella, Diptheria, Pertussis, DtaP, Rotavirus, Hepatitis A or B, Meningitis, HPV. Please Select Yes No Name of the vaccine or vaccines you got* Flu / InfluenzaTetanusPneumonia / PneumococcalChickenpox / VaricellaMMR or MMRV (Measles, Mumps, Rubella)DTaP (Diphtheria, Tetanus, and Pertussis)HPV / GardasilWhooping Cough / PertussisRotavirusHepatitis A or Hepatitis BMeningitis / MeningococcalHib / Haemophilus Influenzae Type BPolioOther non-COVID vaccine What year did you get the Non-COVID vaccination(s)? Before 20222022202320242025 Have you seen a doctor or medical professional for treatment?* Please Select.. YES NO What was your diagnosis? Name/Brand of Hip Implant:* Please Select.. Biomet Johnson & Johnson DePuy Pinnacle DePuy ASR Zimmer Stryker Wright Medical Other I Don’t Know What year was the original hip replacement surgery? Before 2015After 2015 Did your doctor talk to you about metallosis, pseudotumors, high metal levels in your blood, bone loss, osteolysis, or joint loosening? Please Select.. YES NO Did You Have Revision Surgery or Are You Scheduled for Revision Surgery?* Please Select.. YES NO Date of revision surgery or upcoming revision surgery What are the names of the kratom brands that were used? OPMSWhole HerbsRemarkable HerbsMIT 45Hush KratomKratoMadeDr. Kratom7-OHMZPure OhmsZohm7TabzOpia HydroxyCBD American ShamanOther brand not listed above If Other, what was the name of the brand? Is this about a kratom death? Please Select.. YES NO If there is an autopsy report, what was the cause of death? If there is a toxicology report, what substances are listed? Are you a member of a tribe? Please Select.. YES NO Is your question about a tribal matter? Please Select.. YES NO What is the name of the tribe: What is the tribe’s location? Did you take any of the following medications? OzempicWegovyMounjaroTrulicityRybelsusZepboundOther Was your medication the name brand or generic/compounded? Name BrandGeneric/CompoundedI don’t know What state or states did you live in when taking the medication? Which form of medication did you use? Pre-loaded injection penVial of medication with syringe injectionPill formOther Are you still taking the medication now? Please Select.. Yes No Have you been diagnosed by a doctor with any of these conditions: Gastroparesis, stomach paralysis, gastric stasis, delayed gastric emptying intestinal blockage, bowel obstruction, ileal blockage?* Please Select.. Yes No Have you been diagnosed with any of these conditions? Check all that apply. PancreatitisDeep Vein ThrombosisEye or vision strokeGallstones or gallbladder issuesThyroid issuesKidney issuesStomach ulcersDiabetesOther If Other, please describe: Did you have non-rent paying tenants between Sept. 4, 2020 and October 2, 2021? Please Select YES NO Do you have a copy or can you get a copy of the tenant’s Eviction Protection Declaration Please Select YES NO I don't know How many of your rental properties were impacted by the eviction moratorium? Did you experience a severe injury related to a food recall? Please Select.. YES NO What kind of medical treatment did you undergo? Do you have receipts or the packaging from the recalled food product? Please Select.. YES NO Did you start taking Depo Provera AFTER 1992. Please Select YES NO About how many injections of Depo-Provera have you had? Please Select 1 injection 2 or more injections Have you been diagnosed with a meningioma tumor? Please Select Yes No What is your diagnosis after taking Depo-Provera? Name of the clinic or medical provider where you got the prescription for Depo-provera. In what state do you currently live? Tell us if there are additional details about your situation we should know about. Is this about the Inspire IV Implantable Pulse Generator? Please Select Yes No Other What date did you have surgery to implant the Inspire device?: Did you have surgery to remove or replace the device or are you scheduled to have surgery? Please Select Yes No Other What date did you have revision surgery to remove the Inspire implant? What were the symptoms that indicated something was wrong? Please add additional information about what happened. Intake Score Submit Should be Empty:
