Last Step! Congratulations! We want to thank you for taking the time to fill out your Proton Pump Inhibitor (PPI) contract. In order for us to move forward with your case, please fill out the following: Full Name(required) Phone Number(required) Email Address(required) What years did you take Nexium, Prilosec, or Prevacid?(required) What Pharmacy did you use?(required) What type of injury/symptoms occurred?(required) Kidney Injury Kidney Failure Kidney Disease Nephritis Other What Hospital treated you for your injury? What year did you suffer your injury? Additional Information Submit
