Xarelto Litigation Questionnaire

Name:

Address:

Email:

Telephone:

Date Xarelto was prescribed:

What injury(s) do you believe are related to your use of Xarelto?

Date of Injury:

Have you stopped taking Xarelto? Yes No

Did a doctor ever tell you that you were injured as a result of Xarelto? Yes No

Were you hospitalized for your injuty(s) resulting from taking Xarelto? Yes No

Did your physician monitor you while on Xarelto? Yes No

Did you ever have blood work taken while on Xarelto? Yes No

Personal Injury attorney Disclaimer: This website provides public information regarding Xarelto and potential lawsuits. None of the information provided is intended to be formal legal advice nor does this information form an attorney-client relationship