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Bay Area Mesothelioma Attorneys
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Case Information
Were you or loved one diagnosed with any of the following?
Asbestosis
Mesothelioma
Lung Cancer
Asbestos Related Cancer
No Diagnosis
Other
If other please describe
Who diagnosed the injured person?
Doctor
Physician
Hospital
Medical Center
Self Diagnosed
No Diagnosis
What year was the injured person diagnosed?
Before 2001
2002
2003
2004
2005
2006
2007
2008
What state was the injured person diagnosed in?
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AK
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AR
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CO
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HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
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ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Was injured/diagnosed or deceased person exposed to Asbestos?
Yes
No
Not Sure
In what state was the injured/diagnosed or deceased person exposed to Asbestos?
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Age of injured/diagnosed or deceased person (if deceased please choose age at time of passing):
Age
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
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80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Did injured/diagnosed or deceased person smoke?
Yes
No
Is the person alive or deceased?
Alive
Deceased
If deceased what was the date of death
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Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
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1982
1981
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1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
If death occurred, please list cause of death on death certificate
Has injured/diagnosed or deceased person participated in or received money from a previous asbestos related legal claim or lawsuit?
Yes
No
Do you or injured/diagnosed or deceased person currently have a lawyer or law firm representing you in an asbestos related legal claim or lawsuit?
Yes
No
Questions, comments, additional information
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The Law Firms of Steigerwalt & Associates and Levin, Simes, Kaiser & Gornick are working to help victims of serious injury and death as a result of Mesothelioma.
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