Free consultation at Gold, Khourey & Turak about Prempro








Gold, Khourey & Turak 510 Tomlinson Ave. Moundsville WV 26041 Phone: 304-845-9750 Toll Free: 800-388-2529

You can use the form below or you can
contact us at 304-845-9750 or toll free 800-388-2529

*Title:**
*First Name:**	MI	*Last Name:**


*E-mail Address:**
*Home Phone:**
Work Phone:
Mobile Phone:
Street Address:
City:
State / Zip:	/

Injured Person Information:

Date of Birth:

Whom are you inquiring on behalf of?
If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased?	Yes No
If deceased, the cause of death as stated on the death certificate:
Date of Death:
Was there an autopsy performed?	Yes No n/a

Prempro

During what period of time was Prempro used?
Start End

Please list name and address of doctor who prescribed Prempro:

Why was Prempro prescribed?:

Did you smoke cigarettes while taking Prempro? Yes No
If yes, how many packs per day?

Did you smoke cigarettes before taking Prempro? Yes No
If yes, how many packs per day?

Does breast cancer run in family? Yes No

If yes, please describe family member's breast cancer diagnosis:

Do blood clots or strokes run in family? Yes No

If yes, please describe history of blood clots and strokes:

Were any of the following problems experienced while taking or after taking Prempro?

Heart Disease	Yes	No
Heart Attack	Yes	No
Stroke	Yes	No
Blood Clots	Yes	No
Breast Cancer	Yes	No
Other	Yes	No

If other, please describe:

If diagnosed with breast cancer please describe diagnosis:

Other Information:

Yes No - I agree that this matter may be referred to an attorney in my area who may contact me.

Yes No - I agree that by submitting this question, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.

Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

By Clicking the appropriate box below, I agree to:


Medical Study
National Heart, Lung, and Blood Insitute (NHLBI) launched a study to determine the long term effects of Prempro. The study was originally planned for 8 years, but was stopped after 5 years when researchers determined the overall health risks exceeded benefits.