PFAS Lawsuits

Relationship*

Address

How would you prefer to be contacted?*
EmailPhoneMail

Name of person injured or sustained property damage from PFAS?

Did person receive personal injury diagnosis after exposure to PFAS?
YesNo

Receive Kidney Cancer Diagnosis after exposure to PFAS?
YesNo

Receive Liver Cancer Diagnosis after exposure to PFAS?
YesNo

Receive Testicular Cancer Diagnosis after exposure to PFAS?
YesNo

Receive Ulcerative Colitis Diagnosis after exposure to PFAS?
YesNo

Was person exposed to PFAS work(ed) as a firefighter?
YesNo

Did person sustain property damage from PFAS?
YesNo

Did damaged property require remediation?
YesNo

Please provide any additional comments regarding personal injuries or property damages: