Why this victim registration?
In order to gain a good (international) overview of the health-related complaints relating to articaine, it is important to get in contact with potential victims and their relatives. We have formulated a number of questions to make this possible.

Please be advised that the answers to these questions could serve as the basis for future legal cases.

It is of outmost importance to state that any information that you supply will never be submitted to any third party without your express permission. If for any reason we should want to use this information, you will be contacted in advance.

* Sex Men Woman
* Name:
Adress:
Mail code:
City:
* Land:
Telephone:
*E-Mail Adress:
Why do you believe yourself to be a victim of articaine?
What are your symptoms?
When were you treated with this product?
For what reason were you treated and by whom?
How often have you been treated with articaine?
Have you already taken legal action? Yes No
Other comments:
* = Obligatorily