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Address:
1311 Avenida Ponce de Leon
6th Floor
San Juan, PR 00907

Phone:
800-900-7704

Email:
info@cancersettlement.com

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WAS YOUR CANCER CAUSE BY TALCUM POWEDER?

Case Evaluation

Case Evaluation

Step 1 of 4

25%

[1.] Diagnosis
Have you been diagnosed with one of the following types of cancers that have been associated with a dangerous product?*
- Non Hodgkins Lymphoma
- BIA-ALCL (a type of T-cell Lymphoma)
- Liver
- Pancreatic
- Bladder
- Esophageal
- Gastric
- Breast
- Colorectal
- Leukemia
- Lymphoma
- Prostate
- Testicular
- Thyroid
- Lung
- Mesothelioma
- Ovarian
- Other
What type of Cancer?*

[2.] Exposure
Have you been exposed to Round up?*
- Yes
- No
Do you have Textured breast implants?*
- Yes
- No
Have you been exposed to Talc?*
- Yes
- No
Have you been exposed to Asbestos?*
- Yes
- No
Have you been exposed to AFFF (Fire Foam)?*
- Yes
- No
Have you been exposed to Zantac?*
- Yes
- No
When were you diagnosed?*
MM slash DD slash YYYY
What was your state of residence when you were diagnosed?*
What is your Date of birth / Age*

[3.] Past Experience
Have you ever or are you currently represented by an attorney for this matter?*
- Yes
- No

[4.] Contact Information
First Name*
Last Name*
Phone Number*
Email*
Street Address*
City*
State*
Zipcode*

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