Drug Litigation
 

This is a request from you to the law firm asking for a proposed attorney-client agreement. You will not be a client and this law firm accepts no responsiblity for your C-8 related claim, until both you and a representative of the law firm have both signed the attorney-client contract which will be sent to you. Submission of this form does not create any obligation on you or the law firm. Our representation will not start until an attorney-client agreement is signed and in the possession of both you and the law firm.

In order for us to accept you as a client, our law firm and the other two law firms with which we are associated (Taft, Stettinius & Hollister, llp, located in Cincinnati, Ohio, and Winter Johnson & Hill pllc, located in Charleston, West Virginia) must first determine that there is no conflict of interest. If a conflict is discovered, you will be promptly notified. If you do not hear from us within two weeks of submitting this form, please call 800-822-5667 and inquire.

Full Name

Mailing Address

City, State & Zip Code

Street Address

City, State & Zip Code

EMail Address

Phone Number(s)

Have you ever had your water supplied by Parkersburg, Lubeck, Belpre, Little Hocking, Pomeroy, Tuppers Plains/Chester, or Mason County PSD? YES NO

If YES, length of time on this water source

Were you exposed to C-8 from some other source (i.e. water at work, school or daycare)?

YES NO

Information for others living in your home, NAME, RELATIONSHIP, DATE OF BIRTH:

Did you participate in the Brookmar Health Project?

YES NO

If you participated, did you retain your C-8 blood level results?

YES NO

 

Comments or Additional Information Requested

We cannot promise that the claim will be successful and we cannot presently provide information as to what diseases or defects may, or may not, be linked to C-8 exposure. Scientific studies are presently ongoing. All legal claims are governed by time limits and we do not accept the responsibility to monitor time deadlines for persons who are not our clients. No person is our client until a signed attorney-client agreement is received and accepted at our office. A signed duplicate copy will be returned to you. If you do not hear from us within two weeks of submitting this form, please call 800-822-5667 and inquire.

 

DISCLAIMER:
Your email is initiated at the www.hpcbd.com website, and is directed to one or more attorneys or staff persons at Hill, Peterson, Carper, Bee & Deitzler, PLLC. The content of any submitted email is provided by and is the responsibility of the person posting the email communication, meaning the person who is filling out this form and submitting it to the law firm. In making your inquiry in this manner, you understand that your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in or through such email communications is at your own risk.

 

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