masstortintakedepo-provera.com.aas.ojr.temporary.site Open in urlscan Pro
192.185.16.134  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" action="">
  <!-- Affected Individual Section -->
  <div class="mb-3">
    <label class="form-label">Is the affected individual you or a loved one? <span class="text-danger">(Required)</span></label>
    <div>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="affected_individual" id="self" value="self" required="">
        <label class="form-check-label" for="self">Myself</label>
      </div>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="affected_individual" id="lovedOne" value="loved_one" required="">
        <label class="form-check-label" for="lovedOne">Loved one</label>
      </div>
    </div>
  </div>
  <!-- Condition Section -->
  <div class="mb-3">
    <label for="condition" class="form-label">Have you or a loved one developed any of the following conditions after using Depo-Provera? <span class="text-danger">(Required)</span></label>
    <select id="condition" name="patient_condition" class="form-select" required="">
      <option value="" disabled="" selected="">Select a condition</option>
      <option value="meningioma">Meningioma</option>
      <option value="brain tumor">Brain tumor</option>
      <option value="other">Other</option>
      <!-- Add other conditions as options here -->
    </select>
  </div>
  <!-- Lawyer Representation Section -->
  <div class="mb-3">
    <label class="form-label">Do you currently have a lawyer representing your claim? <span class="text-danger">(Required)</span></label>
    <div>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="lawyer" id="yes" required="">
        <label class="form-check-label" for="yes">Yes</label>
      </div>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="lawyer" id="no" required="">
        <label class="form-check-label" for="no">No</label>
      </div>
    </div>
  </div>
  <!-- Contact Information Section -->
  <div class="mb-3">
    <label for="email" class="form-label">Email <span class="text-danger">(Required)</span></label>
    <input type="email" id="email" name="email" class="form-control" placeholder="Enter your email" required="">
  </div>
  <div class="row">
    <div class="col-md-6 mb-3">
      <label for="firstName" class="form-label">First Name <span class="text-danger">(Required)</span></label>
      <input type="text" id="firstName" name="first_name" class="form-control" placeholder="Enter first name" required="">
    </div>
    <div class="col-md-6 mb-3">
      <label for="lastName" class="form-label">Last Name <span class="text-danger">(Required)</span></label>
      <input type="text" id="lastName" name="last_name" class="form-control" placeholder="Enter last name" required="">
    </div>
  </div>
  <div class="mb-3">
    <label for="phone" class="form-label">Phone <span class="text-danger">(Required)</span></label>
    <input type="tel" id="phone" name="phone" class="form-control" placeholder="Enter phone number" required="">
  </div>
  <div class="mb-3">
    <label for="address" class="form-label">Street Address <span class="text-danger">(Required)</span></label>
    <input type="text" id="address" name="address" class="form-control" placeholder="Enter street address" required="">
  </div>
  <div class="mb-3">
    <label for="city" class="form-label">City <span class="text-danger">(Required)</span></label>
    <input type="text" id="city" name="city" class="form-control" placeholder="Enter city" required="">
  </div>
  <div class="mb-3">
    <label for="consent" class="form-label">
      <input type="checkbox" id="consent" name="consent" required=""> By clicking the 'Submit' button, you provide your electronic signature and represent that you are at least 18 and agree to our Privacy Policy and Terms and Conditions. By
      submitting this form, you expressly agree to be contacted by Masstort Intake Depo-Provera regarding your inquiry. This consent allows us to reach you by email or telephone (including text messages, autodialed/auto-selected or pre-recorded and
      articial voice calls and the use of articial intelligence), even if your number is listed on any state or federal Do Not Call list. You also approve the use of call recording and monitoring of all your inbound and outbound calls with Masstort
      Intake Depo-Provera and its referrals. I understand that my consent is not required as a condition of purchasing goods or services and can be revoked at any time I conrm that I accessed, read, and understood the pages: Partners, Privacy Policy,
      and Terms of Use </label>
  </div>
  <!-- Submit Button -->
  <div class="d-grid">
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
  <input type="hidden" name="xxTrustedFormCertUrl" value="https://cert.trustedform.com/e1b0cd963322d2684ca465d9bf01fc326b3c22c8" id="xxTrustedFormCertUrl_0"><input type="hidden" name="xxTrustedFormToken"
    value="https://cert.trustedform.com/e1b0cd963322d2684ca465d9bf01fc326b3c22c8" id="xxTrustedFormToken_0"><input type="hidden" name="xxTrustedFormPingUrl"
    value="https://ping.trustedform.com/0.NtJO9d4EOH-R9XrGekOlc-G_Fva5tKNciYzD4CoqIdSL6sfQm41zTiVKHJKvr4DH38Knz20.OdmnhUpgaurieCBkU7qvTg.J5q3_WdP4rt4VRjsg0nSDA" id="xxTrustedFormPingUrl_0">
</form>

Text Content

Masstort Intake Depo-Provera

NEED HELP? (877) 392-0395


GET MY FREE CLAIM REVIEW

Attention! Time-sensitive lawsuits are now being filed! You may be entitled to
financial compensation! Complete the free and easy claim reviews below that
apply to you or a loved one.

*** NO ONE CAN GUARANTEE A SPECIFIC SETTLEMENT AMOUNT OR TIMELINE. ***




FILL OUT THE FORM BELOW TO GET YOUR FREE CLAIM REVIEW

You may be entitled to nancial compensation! Your Information is 100%
Condential. IMPORTANT INFORMATION ABOUT YOUR POTENTIAL CLAIM

*** NO ONE CAN GUARANTEE A SPECIFIC SETTLEMENT AMOUNT OR TIMELINE. ***

GET MY FREE CLAIM REVIEW
Is the affected individual you or a loved one? (Required)
Myself
Loved one
Have you or a loved one developed any of the following conditions after using
Depo-Provera? (Required) Select a condition Meningioma Brain tumor Other
Do you currently have a lawyer representing your claim? (Required)
Yes
No
Email (Required)
First Name (Required)
Last Name (Required)
Phone (Required)
Street Address (Required)
City (Required)
By clicking the 'Submit' button, you provide your electronic signature and
represent that you are at least 18 and agree to our Privacy Policy and Terms and
Conditions. By submitting this form, you expressly agree to be contacted by
Masstort Intake Depo-Provera regarding your inquiry. This consent allows us to
reach you by email or telephone (including text messages,
autodialed/auto-selected or pre-recorded and articial voice calls and the use of
articial intelligence), even if your number is listed on any state or federal Do
Not Call list. You also approve the use of call recording and monitoring of all
your inbound and outbound calls with Masstort Intake Depo-Provera and its
referrals. I understand that my consent is not required as a condition of
purchasing goods or services and can be revoked at any time I conrm that I
accessed, read, and understood the pages: Partners, Privacy Policy, and Terms of
Use
Submit


WHAT DO WE KNOW ABOUT DEPO-PROVERA LAWSUITS?

Lawsuits related to Depo-Provera allege that the injectable contraceptive,
manufactured by Pzer, increases the risk of developing brain tumors,
particularly meningiomas, after long-term use. The lawsuits accuse the company
of failing to provide adequate warnings about these risks, neglecting its duty
to inform patients and doctors. Claims also include allegations that Pzer
downplayed or omitted information about the potential dangers of the drug,
leading many users to seek compensation for damages such as medical expenses and
emotional distress

GET MY FREE CLAIM REVIEW


SIGNS & SYMPTOMS

 * Irregular menstrual periods or no periods at all
 * Which is a safe benefit of the shot
 * Headaches
 * Nervousness
 * Depression
 * Acne
 * Changes in appetite
 * Weight gain
 * Excessive growth of facial and body hair


MASSTORT INTAKE DEPO-PROVERA



© 2024 . Masstort Intake Depo-Provera

Privacy Policy

Terms Of User