File A Claim Mesothelioma Lawsuit FILL OUT THE FORM BELOW TO GET YOUR FREE CLAIM REVIEW Mesothelioma Lawsuit Do you any proof of diagnosis, such as treatment records or pathology reports or medical portal. Yes NoDid you sign any paperwork or speak to any law firm to represent you for this claim? Yes NoIs this for you or for someone? Myself family (living) family (deceased)When were you diagnosed with Mesothelioma? Has a biopsy been performed? No YesIf YesOn what part of your body was the biopsy performed? Yes NoIf NoHas a fluid testing/cytology testing been performed? Yes NoFluid or cytology testingWhat is the facility name, city, and state where you are diagnosed with cancer?Please provide the name of the doctor that diagnosed you with Mesothelioma. Diagnosing doctorAt which hospital did you receive your diagnosis?During what year were you exposed to asbestos? Exposure dateWhich states were you exposed to asbestos?Did you ever work at any industrial facilities before December 31, 1982? Worked at facilities before 1982 ? Yes NoDid you ever serve in the United States Navy (or other Armed Forces) before December 31, 1982? Yes NoFirst Name & Last NameEmailPhone NumberStreet AddressAddressAddress Line 1CityStateZip Code I would be needing help to file a settlement. I agree to the Privacy Policy and disclaimer and give my express written consent, affiliates and/or attorneys to contact you at the number provided above, even if this number is wireless or if I am presently listed on a Do Not Call list. I understand that I may be contacted by telephone, email, text message, or mail regarding case options and that I may be called using automatic dialing equipment. Message and data rates may apply. I don't need to purchase my consent. This is Legal advertising. I understand I will be asked for medical records, and if falsified, I will be held liable for knowingly providing false information and the Law Firm reserves the right to seek all available remedies under the law.Date / TimeSubmit Form
