Talcum Powder Lawsuit Questionnaire

The answers you give on this form are for our use only in the evaluation of a potential personal injury claim. Although some questions may ask for personal information, all questions have a legitimate purpose.

The thorough evaluation of your claim depends upon the accuracy and completeness of your answers. All answers are confidential.

Filling out this form does not create an attorney-client relationship between you and Davis Law Group. Although we will review your information and evaluate your potential claim, this does not mean that we have or will agree to represent you.

Talcum Powder Case Evaluation Questionnaire

In order for our attorneys to properly investigate and evaluate your claim, you must fill out all of the fields on this form. All of your answers and personal information will be kept confidential.

Full Name *

Date of Birth *

Address *

City *

State *

Zip *

Country *

Contact Name *

Phone *

Email *

Products Taken? *

Injuries or Illnesses *

Medical Treatment? *

Did Victim Have BRCA1 or BRCA2 Gene Mutation? *

Other Details

Terms & Conditions:

I understand that the answers given on this form are only for the evaluation of a potential personal injury or wrongful death claim. Filling out this form does not create an attorney-client relationship between you and Davis Law Group. I understand that Davis Law Group will review the information and evaluate the potential claim but may or may not agree to represent me in this matter. *