Roundup Qualification

1

Have you ever used Roundup weed killer at home, on the job, or on agricultural property?* This field is required.

YESNO

2

Did you use Roundup in your work for at least six months?* This field is required.

YESNO

3

Did your use of Roundup occur before 2021?* This field is required.

YESNO

4

Were you consistently exposed to Roundup while working in farming, landscaping, groundskeeping, or commercial gardening?* This field is required.

YESNO

5

Have you been diagnosed with non-Hodgkin’s lymphoma, B-cell lymphoma, chronic lymphocytic leukemia, or a similar blood-related cancer by a licensed physician?* This field is required.

YESNO

6

Has it been less than 5 years since diagnosis?* This field is required.

YESNO

7

Were you under the age of 70 at the time of your diagnosis?* This field is required.

YESNO

8

Have you already filed a claim or hired a lawyer regarding Roundup exposure?* This field is required.

YESNO

9

Please Share Your First & Last NameThis helps our team find your records should you qualify

First Name

Last Name

10

Type a question

11

Has it been less than 10 years since your cancer diagnosis?* This field is required.

YESNO