Forms, Evaluation, NC Personal Injury Attorneys, Head Injury Lawyers, Pharmaceutical Negligence

Ted A. Greve & Associates

I was in real pain and afraid about my future. Ted Greve & Associates helped get my work comp straight. I've worked hard and I expect to be treated fairly. - Joan Bell A friend told me about Ted Greve and Associates. They have convenient locations all over the area. I don't like driving in traffic so they came out to explain what had to be done . . . and did it! I am very satisfied with the results. - Pat Cochrane I didn't know what to do. But a friend told me about Ted Greve & Associates. Dr. Ted took the time to make things right. I was still hurting . . . but Ted Greve & Associates was with me every step of the way. - Steve Southern

PRESCRIPTION NEGLIGENCE FREE EVALUATION FORM

* Items are required. There is no charge for this evaluation.

CONTACT INFORMATION

First Name:* Last Name:*

*E-mail Address:

Home Phone:
- -

Cell Phone: - -

Work Phone: - - ext.

Street Address:

Address #2:

City:

State/Zip: /

What is the best way to reach you?
Please provide the best place, time and method for contacting you.

PRESCRIPTION DRUG INFORMATION

What prescription medication are you inquiring about?
Other:

How long was the medication taken?

When did you start taking the prescription?

When did you stop taking the prescription?

Your date of birth:

Please list any medical conditions you had prior to taking the medication:

Please tell us why the medication was prescribed:

Have you suffered any serious medical side effects since taking this medication?
Yes No

Please describe your side effects:

Have you suffered any cardiovascular problems? Yes No

Were you taking any additional medications? Yes No
If so, please list other medications:

How did you hear about us?

Name:

Phone:

Email:

How did you hear about us?

Comment/Questions:

*Client may be responsible for certain costs, i.e., court cost, etc.

**We do not represent that similar results will be achieved in your case. Each case is different and must be evaluated separately. Membership in the Million Dollar Advocates Forum is limited to successful trial lawyers who have demonstrated exceptional skill, experience and excellence in advocacy by achieving a trial verdict, award or settlement in the amount of One Million Dollars or more. For additional information on the Million Dollar Advocates Forum please refer to www.milliondollaradvocates.com

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Head Injuries, Personal Injury, Pharmaceutical Negligence, Social Security Disability, Workers Compensation, Wrongful Death, Bextra, Celebrex, Vioxx, Zyprexa
Serving North Carolina - Cabarrus County, Concord, Catawba County, Hickory, Newton, Cleveland County, Shelby, Durham County, Durham, Gaston County, Gastonia, Mount Holly, Guilford County, Greensboro, Iredell County, Mooresville, Statesville, Lincoln County, Westport, Lincolnton, Mecklenburg County, Huntersville, Charlotte, Rowan County, Kannapolis, Salisbury, Union County, Monroe, Indian Trial, Wake County, Raleigh, Rock Hill, South Carolina
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