Tylenol Intake Form

If you have a child diagnosed with autism or ADHD and would like to speak with our firm about representation in a lawsuit against the companies that make and sell Tylenol and acetaminophen, please answer the questions in the form below.

You should know that our work is on a contingency fee basis, which means that the client will not owe any fees or costs unless there is a financial recovery for the client.

Child Information

Child’s name?

Child’s date of birth?

City and state where child currently lives?

Mother’s Information

Mother’s name?

Mother’s date of birth?

Mother’s address?

Mother’s email address?

Mother’s phone number?

Father’s information

Father’s name?

Father’s date of birth?

Father’s address?

Father’s email address?

Father’s phone number?

Prior Contact with Attorneys

Are you already working with another law firm regarding this claim?

Autism or ADHD Diagnosis

Does your child have autism or attention deficit / hyperactivity disorder? If so, please state which one, or both.

Use of Acetaminophen During Pregnancy

How many times did the mother ingest Tylenol/Acetaminophen during pregnancy?

Less than 15 times

About 15-25 times

Over 25 times

During your second trimester of pregnancy, how often did you take Tylenol or acetaminophen?

During your third trimester of pregnancy, how often did you take Tylenol or acetaminophen?

Any complications during birth? (e.g. emergency c-section, baby loss of oxygen, etc)

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