Free DCPA Exposure Case Evaluation Request Form

Free DCPA Exposure Case Evaluation Request Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please briefly describe your potential exposure to DCPA, including approximately when and where the exposure occured.*
Were you pregnant at the time of your exposure?*

YesNoUnsure
Please briefly describe the health impacts that your child experienced. *
Did you experience any complications from the exposure during pregnancy? If so, please describe them.*
Anything else you'd like us to know?
Disclaimer: Filling out this form does not create an attorney client relationship between you and Cutter Law P.C. Cutter Law may or may not respond to your outreach at its sole discretion. This form may be considered attorney advertising in certain jurisdictions. Cutter Law is located at 401 Watt Ave in Sacramento California. To learn more about Cutter Law or to contact Cutter Law directly, please visit our website: https://cutterlaw.com
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