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RENU USERS:
Submit a Potential Case For Free Review

Thank you for giving us the opportunity to review your potential claim. An attorney will contact you promptly to gather further information and to discuss your case with you. There is no charge for this evaluation.

Please do not leave any fields blank. An asterick (*) indicates required information. Please read the disclaimer below. Thank you.

Please Note: This form is for non-lawyers to submit a potential claim. If you are an attorney and wish to refer a case to the law firm of Howard L. Nations, Attorneys Please Click Here.

Privacy Policy (Please Read):
The Law Offices of Howard L. Nations does not reveal customer information to any individual, vendor, company, direct marketer, trade group or other external organization, unless required by law. We maintain control over the confidentiality of our customer information.

All correspondence between our users and The Law Offices of Howard L. Nations is protected by client/attorney privilege. However, you should be aware that email is not a secure method of communication, and should never provide sensitive information, such as your social security number or credit card numbers, via email.

Filling out this form gives The Law Offices of Howard L. Nations the right to both confidentially email a response and/or call on the telephone (regardless of subscription to Do Not Call lists.)


Title

First Name (Required)*

Last Name (Required)*

Email Address (Required)*

Please Re-type Email Address

Street Address (Required)*
Apt./Suite

City (Required)*

State or Province (Required)*

Zip Code (Required)*

County

Home Number including Area Code (Required)*

Office Number including area code

Cell Number including area code

Best way to contact you
(Please provide best place, time, method of reaching you)

Have you contacted any other lawyers about this matter?

Yes No

Are you currently represented by an attorney? (Required) *

Yes No

Your Case Information

Are you the injured person?

Yes No

If not, please state the name of the injured person and their relationship to you.

Name
Relationship

Please describe the nature of your complaint in one brief sentence.

Date of Birth of the Injured Person:

Which of the following ReNu products did you use? (check all that apply)

ReNu with MoistureLoc

ReNu MultiPlus®

ReNu Multi-Purpose

Not Sure

If Other, please describe:

After using ReNu with MoistureLoc, did you experience any of the following? (Check all that apply)

Eye pain

Foreign body sensation

Redness of the eyes

Tearing/watery eyes

Discharge from the eyes

Sensitivity to Light

Not sure

None of the above

If so, when did this occur?

(month and year)

Have you been diagnosed with Fusarium keratitis?

Yes

No

Not Sure

If Yes, when were you diagnosed?

(month and year)

Which of the following treatments has your doctor recommended? (Check all that apply)

Eye drops

Antibiotic pills

Corneal transplant

Other surgical procedure

Not sure

None of the above

Additional Details Related to Your Case:

How did you find our website?

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Disclaimer

This Web site is a public resource for general information about our firm. Nothing in this Web site should be used by the reader as a source of legal advice. Each legal problem is different, and past performance does not guarantee future results. This Web site does not create an attorney-client relationship between you and The Law Offices of Howard L. Nations, P.C., nor is it intended to do so. Please do not act or rely on any information in this Web site.

The fact that we are reviewing and evaluating your potential claim does not create an attorney-client relationship between you and the law offices of Howard L. Nations, P.C., nor is it intended to do so. An attorney-client relationship is formed when we agree to handle your case and contracts are signed.

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