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I am a victim of:
I was affected in:
If other, please list (not published):
First exposure took place in:
Others Affected Are:
My Status Now Is:
My Medical Status Is: (Check all that apply) Treatment by Physician
Treatment by Medical Specialist
Treatment by Environmental Specialist
Treatment by Neurologist
Treatment by Holistic Physician
Self Treatment
Not Being Treated
Other, Not Listed
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CLASS ACTION REPORT FORM
Join others in class action.
WANTED: Employees or ex-employees with toxic mold injuries from UNITED HEALTHCARE or UNIPRISE in Kingston, NY. E-Mail with UHC CLASS ACTION in subject line.
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