• Omniscan
  (Gadodiamide, Manufacturer: GE Healthcare)
• OptiMARK
  (Gadoversetamide Injection, Manufacturer: Mallinckrodt/Tyco Healthcare)
• Magnevist
  (Gadopentetate Dimeglumine Injection, Manufacturer: Bayer HealthCare Pharmaceuticals/ Schering AG/Berlex)
• ProHance
  (Gadoteridol Injection, Manufacturer: Bracco Diagnostics)
• MultiHance
  (Gadobenate Dimeglumine, Manufacturer: Bracco Diagnostics)

First Name Last Name Email Address Phone Number Cell Phone Number Street Address City State Choose State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Please describe kidney problems / failure:

Date of birth of injured person (mm/dd/yyyy)
Date of MRI / MRA: Were you injected with a gadolinium-based contrast agent?
Yes No

Have you been diagnosed with Nephrogenic Systemic Fibrosis/ Nephrogenic Fibrosing Dermopathy?
Yes No

Other Comments:
By sumbitting this form I agree to the following disclaimer.

Kidney patients with NSF / NFD have legal rights.

NSF / NFD can be serious and fatal.

If you were injected with a gadolinium contrast agent during an MRI or MRA, contact us today.

We take NO legal fees unless we win financial compensation for you.

Please fill out the form at the left for a FREE and CONFIDENTIAL case review.