PFAS Justice Legal Network – No-cost AFFF/PFAS Case Evaluation

AFFF* / PFAS** Chemical Exposure

CLAIM EVALUATION FORM

TAKES ABOUT 4 MINUTES
Your information is confidential and will not be shared with any 3rd parties without your consent. This submission does not constitute a request for legal advice and does not form an attorney client relationship.

I agree to this disclaimer: By pressing "Request for a No-Cost Evaluation", I agree to receive a message, email, and/or phone call from one of the PFAS Justice Legal Network's associated attorneys or administrative personnel, to the provided mobile number or land line and agree to the terms and privacy policy. Message & data rates may apply. Reply STOP to cancel.

First Name

Last Name

Phone Number

Email Address

Which cancer or health condition were you diagnosed with?

Date of Diagnosis? (Choose the month and year first, then choose day.)

Diagnosed in which state?

Prior to your diagnosis, did you work as any of the following?

Do you believe you were exposed to AFFF Foam, and if so, how long?

Do you believe you were exposed to PFAS contaminated Turnout Gear, and if so, how long?

Please feel free to comment or ask any questions you may have.

Disclaimer: By pressing "Request for a No-Cost Evaluation", you agree to receive a message, email, and/or phone call from one of the PFAS Justice Legal Network's associated attorneys or administrative personnel, to the provided mobile number or land line and agree to the terms and privacy policy. Message & data rates may apply. Reply STOP to cancel.

*AFFF (Aqueous Film-Forming Foam) is primarily used to fight fires involving Class B materials, which include gasoline, oil, and jet fuel.

** PFAS is a constituent of AFFF and has been found in protective Turnout Gear.

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info@pfasjusticelegalnetwork.com

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