Please answer all questions fully to the best of your ability. Some questions may not apply to your specific case. In that situation, simply put ‘N/A’ as your entry. If you do not know the answer to a particular question, you should state ‘Unknown’ as your entry.
Please list the names of all known doctors and medical facilities that treated Claimant for their injuries/conditions related to the toxic water exposure. (Ex: Dr. John Doe, Montgomery Clinic, Chemotherapy 2015-2017)
Please provide any other facts or information that you believe may be relevant to this case.
If you have copies of Claimant’s Military Records such as DD214s, Medical Records, Death Certificate (If Applicable), Last Will (If Applicable), or other relevant documents, please upload them here. If you are unable to upload, please email the files to firstname.lastname@example.org or mail physical copies to our Mobile, AL office located at 1 St. Louis St., Suite 1002, Mobile, AL 36602.
Max. file size: 20 MB.
Drop files here or