West Virginia Rezulin Class Action - Claim Form and Release

Claim Form and Release

Each Claim Form and Release document is available below as a downloadable Adobe^® Acrobat^® PDF document for viewing and printing.

Use this Claim Form if you do not want to release your personal injury claims and wish to make a claim for $200.
- Claim Form and Release - $200 Claim - PDF

Use this Claim Form if you agree to release your personal injury claims and wish to make a claim for $1,500.

The Claim Form and Release must be received by February 4, 2008.

Adobe Acrobat Reader is required to view these documents. If you do not have Adobe Acrobat Reader, please click here.