Free Case Evaluation

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Title
First Name*
Last Name*
Email Address*
Phone*
Other Phone
Address
City
State
Zip
What is year were you born?
 Did you consume a beef product with a "sell by date" or "best if used by date" between September 25, 2007, and September 25, 2008?
Yes No

Did you seek treatment from a medical professional?
Yes No
Were you diagnosed with E. Coli?
Yes No Don't Know
Have you contacted an attorney regarding your case?
Yes No
Questions and Comments:*
I understand that submitting this form does NOT create
an attorney client relationship: AGREE