The National Center for Health Research is a non-for-profit organization dedicated to improving the health and safety of adults and children by using research to develop more effective treatments and policies. We are conducting a survey of people who have been seriously harmed by birth control pills or implants. We would like to know your experiences if you or someone close to you has been harmed. Our goal is to take unsafe products off the market and protect the rights and health of all patients.

1. Have you or a family member been seriously harmed by a birth control pill or other product?

2. If you answered yes to #1, in what year was this?

3. If you answered yes to #1, was the product a brand name drug/product or a generic?

4. If a family member was harmed or died, what was her relationship to you?

5. Have you filed a lawsuit?

6. Please list the town or city and state where you live.

7. If you are willing to be interviewed briefly, so that we can help prevent other people from being harmed, please provide a way for us to easily contact you.

For more information about the National Center for Health Research, visit us at