Families Devastated by Opioids Survey

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Please tell us about the problems that your family has faced during the opioid epidemic so that Boyk Law can determine if you or a loved one may be eligible for compensation. Please note that completing this form does not establish an attorney/client relationship, but know that all information provided will be held with strict confidentiality and will not be shared with anyone outside of Charles E. Boyk Law Offices, LLC.

May we text you?

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May we email you?

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How do you prefer to be contacted?

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It is my belief that Opioids caused or led to the following in the opioid user (mark all that apply):

Have you ever been diagnosed with addiction?

YesNo

Have you ever been diagnosed with withdrawals?

YesNo

In your own words, please explain how the opioid user’s family has suffered:

In your own words, please explain how opioids have devastated the opioid user’s life:

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