ONLINE CASE EVALUATION

ONLINE CASE EVALUATION

Complete this free one-minute survey to prequalify for help.
Choose one answer, please:*

I need legal help with a Social Security Disability claim.I want to know if I can get financial compensation because of my cancer diagnosis.

If you are unable to work after a cancer diagnosis, please take this quick survey to prequalify and get the help you deserve. ❤
Are you currently receiving benefits or have you received benefits in the past?

YesNo

Are you between the ages of 50 and 62?

YesNo

Do you already have an attorney representing you in this matter?

YesNo

Out of the last 10 years, have you held a fulltime job for at least half of that time?

YesNo

Do you expect to be out of work for at least 12 months?

YesNo

If you or a loved one has been diagnosed with cancer and believe it may have been caused by exposure to a harmful substance, please take this quick survey to prequalify and get the help you deserve. ❤
Have you or a family member been diagnosed with cancer?*

Yes, I have.Yes, a family member has.No

Do you believe this cancer may have been caused by exposure to a harmful substance?*

YesNo

Have you ever been exposed to any of the following products or physical locations?*

Talcum PowderCamp LeJeuneRoundup Weed KillerNone of These

Have you or a family member ever used talcum powder?*

YesNo

Were you or a family member diagnosed with any of the following cancers after using talcum powder: ovarian cancer, fallopian tube cancer, or mesothelioma?*

YesNo

Was this cancer diagnosed after 2010?*

YesNo

Are you currently being represented by a lawyer for this matter?*

YesNo

Did you or a family member live or work at Camp Lejeune for at least 30 days between 1953 and 1987?*

YesNo

Did you or a family member develop cancer or other health related issues during your time there or after?*

YesNo

Are you currently being represented by a lawyer for this matter?*

YesNo

Have you or a family member been exposed to or used RoundUp Weed Killer?*

YesNo

Were you or a family member diagnosed with Non-Hodgkins Lymphoma or any form of leukemia?*

YesNo

Are you currently being represented by a lawyer for this matter?*

YesNo

Have you or a family member used Zantac medication for more than 3 months?*

YesNo

Were you or a family member diagnosed with bladder, esophageal, gastric, stomach, liver, or pancreatic cancer after taking Zantac?*

YesNo

What state do you reside in?*

Are you currently being represented by a lawyer for this matter?*

YesNo
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