If you or a family member has been diagnosed with Primary Pulmonary Hypertension (PPH), please complete this questionnaire to the best of your ability with as much detail as possible. If you are unsure of the dates, names, addresses, etc., submit the questionnaire and we will obtain any other necessary information at a later date. In the comments section, you may indicate any other pertinent information or requests. If you would like to contact Napoli Bern, LLP for reasons other than a PPH related personal injury claim, please email info@nblawfirm.com or call 1-888-LAW-IN-NY. There is no charge for this evaluation Your Name: Street Address: City: State: Zip: E-mail (required): Phone Number: Work Number: Date of Birth: Who Diagnosed You With PPH?: Have you had an Echocardiogram?   If YES, when?:   Echocardiogram results: Have you had an EKG?   If YES, when?:   EKG results: Comments/Questions? Important Legal Disclaimers: Yes No - I agree that this matter may be referred to an attorney in my area who may contact me. Yes - I understand that I am not forming a formal attorney/client relationship. This PPH Questionnaire is Confidential This site is maintained by Napoli Kaiser & Bern LLP for the convenience of the public and the bar. The contents of any submission will not be disclosed to anyone but the persons monitoring the site for use in discussing potential cases from those fen phen users or victims that submit forms. This questionnaire is not class notice and completion of the questionnaire does not register one for participation in any class action. Rather, this questionnaire is intended to provide basic information necessary to evaluate the merits of any claim for compensation that you may have arising out of your diagnosis of Primary Pulmonary Hypertension (PPH) or use of Fenfluramine (Pondimin) contained in the Fen_Phen combination of drugs and/or Dexfenfluramine (Redux). The information will be used for no other purpose and will be kept strictly confidential as required in any attorney/client relationship. However, completion and submission of the questionnaire does not establish such a relationship and no obligations of any kind exist between you and any member of this website until further discussions and agreements are reached between the parties and an attorney/client agreement is signed. By Clicking the appropriate box below, I agree to: