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Information Request
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OPIOID PRESCRIPTION NATIONAL CLASS
ACTION LAWSUITS INFORMATION REQUEST
The Class of Pain Patients we seek to represent must be certified by a Court. If you fall within any of these groups we have identified above, we are very interested in you and your experiences. We would ask that you share your experience below. If you would like to remain anonymous, please check the box to indicate this. We are asking for your name and contact information so that we may communicate with you. Unless you indicate your wish for your identifying information to be kept confidential, completion of this form is consent to us to utilize the information in connection with the national class actions. Please be aware that providing this information: • Does not obligate you for any cost or expense; • Does not create or obligate either party (you or us) to an attorney-client relationship; and • The information may be used in connection with the Class Action Lawsuits or possibly efforts for legislative remedies. • Any information which may be used to identify you will not be disclosed without your permission. Also, given the number of pain patients suffering from this and related problems, we will likely be unable to respond personally to all emails or to the information provided. Nonetheless, we do appreciate all assistance and look forward to making the lives of pain patients more comfortable and less stressful.
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Email
Phone
Are you a (Check all that apply):
*
Medical Doctor
Pharmacist
Sufferer of Chronic Pain
Patient w/ cancer diagnosis
Patient receiving palliative or nursing home care
Sickle Cell Patient
Legal Guardian of patient
6. Have you had difficulty receiving legitimate prescriptions for opioid medication filled as written at:
*
Select All
Walgreens
CVS
Rite Aid
Costco
b. For each Pharmacy checked, what was the problem you encountered at the Pharmacies?
*
Select All
Refusal to fill
Reduced # of pills
Reduced prescription strength
Required additional prescriptions
Delayed filling prescription
Blacklisted
Humiliated or belittled you
Restriction on prescribing doctor
Restriction based on location of prescribing doctor
Other
I wish to remain anonymous
*
YES
NO
There are many on-line communities of chronic pain patients providing information and support to chronic pain patients. These groups on the internet, such as Don’t Punish Pain, have posted information about our lawsuits on their websites, Facebook, Instagram and other social media. This content is not affiliated with the lawsuits or our effort on behalf of chronic pain patients. The involved law firms and lawyers handling the National Class Action Lawsuits have made no request to any other group, online group, or individuals to raise money to support or fund this case. Please understand no organization except the affiliated lawyers and law firms handling these National Class Action Lawsuits are authorized to speak for us or make any financial or informational request on our behalf. In other words, please be advised that all other individuals or groups are: • NOT authorized to speak on behalf of us or the named plaintiffs in the lawsuits, • NOT involved in the handling or prosecuting of the lawsuits, and • NOT authorized to raise money to cover expenses associated with the lawsuits. IMPORTANTLY – PARTICIPATING IN ANY ONLINE GROUP DOES NOT ENTITLE YOU TO JOIN THE LAWSUIT. “JOINING THESE LAWSUITS” HAPPENS BY OPERATION OF LAW ONCE THE CLASS IS CERTIFIED PROVIDED YOU MEET THE APPROVED CLASS DEFINITION. YOU CAN READ THE PROPOSED CLASS DEFINITION IN THE COMPLAINTS POSTED ON THIS SITE.
Terms of Use and Legal Disclaimers Please read these terms and conditions carefully. If you do not agree to abide by these Terms, do not use or access the websites. These Terms of Use govern your use of this website or social media sites related to this site, including, without limitation, both mobile and online versions of this site. We reserve the right to terminate or limit your access to the websites for any violation of these Terms, or for any other reason, at our sole discretion. (A) By using any one of our social media or websites you accept, and consent to the collection and use of your data for purposes of the legal claims discussed herein. It is agreed that we may change, alter, or modify the settings or configurations on your Device in order to allow for or optimize your use of the websites. (B) No attorney-client relationship is created between you and any attorney or Firm by your access to or use of the this website or any related social media platform or any information contained on any of them. An Attorney-Client Relationship is only Created if and when there is a written agreement signed by you and us. (C) Any information you submit via this website or any related social media platform will not be considered confidential and may be subject to applicable disclosure and reporting requirements, as required by law in addition to possible use for purposes of the legal claims discussed herein. (D) You Should Not Rely on the Information Contained on this Website or any related social media platform. The information provided on the website is general in nature and does not apply to any particular factual, legal, medical, financial, insurance, or other situation, except as specifically described. As such, you should seek professional advice as you determine appropriate. (E) The information on this site is for general informational purposes only. The information presented in this site is not legal advice or a legal opinion, and it may not necessarily reflect the most current legal developments. You should seek the advice of legal counsel of your choice before acting upon any of the information in this site. (F) In some states this website and the information contained on it may constitute a legal advertisement. Our affiliated attorneys do not seek to represent anyone based solely on a visit to this site or upon receiving advertising or social media contact from us where to do so would not comply with applicable law and rules of ethics. None of our attorneys or affiliated attorneys are holding themselves out as specialists or experts in any particular legal field. Our attorneys are licensed to practice law in the state of their residence and other states by admission or pro hac vice. This website makes no representation about the licensure of any attorney in your state or jurisdiction.
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National class-action filed against CVS & Walgreens in Rhode Island and California! Click to view complaints filed!
California Complaint
Rhode Island Complaint
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