The purpose of this survey is to determine if you are a candidate for inclusion in the class action law suit we have brought against Pzifer Inc. of Canada and Pzifer Inc. of the United States, the makers of Celebrex.

Completion of this form does not automatically include you (or the person who suffered harm) in the class action suit. Before you are included we must examine your circumstances and determine your eligibility. Upon ascertaining your eligibility we will send you a retainer agreement between yourself and our firm.

When the retainer agreement has been signed by you and returned to our office, only then you will become a client and prospective member of this class action.

Until the retainer agreement is received and accepted by our firm you are not our client in this matter.

The submission of this survey form is free of charge and in no way obligates you to McPhadden Samac Merner Barry or vice versa.

The information you provide on this form will be kept “strictly confidential”