If you have attempted suicide or a family member has commited suicide contact the Steinberg Law Firm.
Toll Free 888-529-4688
Email andrewsteinberg@lawyer.com
Houston 3200 Travis : 3rd Floor Houston, TX 77006 (713) 529-0025 (713) 751-0412 (fax)
Galveston (409) 762-9090
andrewsteinberg@lawyer.com www.thesteinberglawfirm.com
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Name of Chantix User:
Date of birth of Chantix patient (mm/dd/yyyy):
Was suicide attempted after taking Chantix? Yes No
Did attempted suicide result in death? Yes No
Was hospitalization or institutionalization required after taking Chantix? Yes No