Zantac/Ranitidine California Retailer Survey - Chaffin Luhana
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Zantac/Ranitidine California Retailer Survey

California Zantac/Ranitidine Cancer and Purchase Location Survey

Chaffin Luhana is diligently working on your potential Zantac case and we urgently need your assistance.

Please complete the form below to the best of your ability. 

It is important that you select any/all retailers/pharmacies that you may have purchased Zantac from. Your responses are critical to your claim.

Name(Required)

Diagnosis Information

If you were diagnosed with breast cancer, please select the type below(Required)

Retailers / Locations

Zantac/Ranitidine Purchase Locations

Additional Questions

Do you have a loyalty/rewards card for any of the retailers you selected?(Required)
Did you purchase Zantac/ranitidine by prescription, over-the-counter, or both?(Required)
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