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Primary pulmonary hypertension phen fen settlements
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Confidential Client Questionnaire
First Name:
Last Name:
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Have you been diagnosed with pulmonary hypertension?
 
 No     Yes
Have you been diagnosed with
Primary Pulmonary Hypertension
or Primary Arterial Hypertension?
 
 No     Yes
Did you ever use fen phen, pondimin or redux?
 
 No     Yes
Did you use other diet drugs?
 
 No     Yes
Are you on Treatment such as Flolan, Tracleer, Remodulin, Revatio (Viagra), Ventavis, or other?
 No     Yes
 
Comment / Specific Request:
 
 
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