Do you need a Tequin lawyer to fight for you?

PERSONAL INFORMATION

First Name:

Last Name:

E-mail Address:

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CASE INFORMATION

Dates you took Tequin:

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End Date:

Please check off all side effects that the injured party experienced:

Diabetes
Diabetic Ketoacidosis
Hyperglycemia (high blood sugar)
Hypoglycemia (low blood sugar)
Stroke

Heart Attack
Death
Suicide
Other

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