Please be advised that on February 29th, 2008, the Plaintiff served their Certification Motion Record on the Defendants. The Plaintiff will soon be asking the Court for a date for their Motion for Certification. Further information will be updated as it becomes available.

If you are a user of Mirapex and wish to support the Class Action and be included in our Mirapex Class Action database, please complete the following information form.

Mirapex Class Action
* Indicates a required field:

Name (First and Last): *

Your e-mail address:

Address:

Postal Code:

Date of Birth:

Format example: December 15, 1970

Home Phone Number: *

Alternate Phone Number:

Date Mirapex first prescribed:

Format example: December 15, 1970

Name of Doctor who initially prescribed Mirapex:

Did you experience gambling losses after you began taking Mirapex?:

Yes

No

Estimate the amount of your gambling losses:

Did you experience any other compulsive or obsessive behaviours?:

Yes

No

If you answered "Yes" above, please provide details:

Did you ever have any compulsive or obsessive behaviors before taking Mirapex?:

Yes

No

Date you stopped taking Mirapex:

Format example: December 15, 1970

What made you stop taking Mirapex:

Describe your gambling pattern before taking Mirapex:

When and how did you first learn about the link between your gambling and Mirapex:

Additional Comments:

How has Mirapex affected your life?:

How did you hear about this action?:

By submitting this form, I hereby authorize Thomson, Rogers to list my name in materials to be filed with the Court as a supporter of and a claimant in the proposed Mirapex Class Action.: *

Yes

No

Your advantage, in and out of the courtroom.

Certification Materials Served by the Plaintiff in the Mirapex and Permax Class Actions

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