We handle cases that change lives. Please fill out the form below to see if you qualify. Name* First Last Phone*Email*Were you prescribed Suboxone film for at least 6 months?* YES NO Did you use Suboxone pill or film?* Pill Film Both Did you experience any of the following dental injuries as a result of your Suboxone use: cavities, tooth loss, tooth fractures, tooth decay, tongue injuries, gum injuries YES NO Did you ever visit a dentist prior to Suboxone use? YES NO State where the dental damage startedSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWhat State do you live in? We are currently not accepting clients in Texas, Michigan or TennesseeSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingThanks for your interest! We are sorry, but based on your answers, it looks like we are unable to help you.This field is hidden when viewing the formContent-typeThis field is hidden when viewing the formweb sourceThis field is hidden when viewing the formCase TypeThis field is hidden when viewing the formQuestion 1This field is hidden when viewing the formQuestion 2This field is hidden when viewing the formQuestion 3This field is hidden when viewing the formQuestion 4This field is hidden when viewing the formIf_API_GeneratedThis field is hidden when viewing the formwebsourceThis field is hidden when viewing the formPrimaryPhoneEmailThis field is for validation purposes and should be left unchanged. Δ