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800-797-5391

Home
Types of Cases
About the Firm
Resources
Contact
- Contact Us
- Locations

Available 24/7
Contact Us For A Free Consultation
800-797-5391

Camp Lejeune – Contact Us

Home
Camp Lejeune – Contact Us

Camp Lejeune

"*" indicates required fields

Did you (or a loved one) live and/or work on the Camp Lejeune base for at least 30 days between August 1, 1953 and December 31, 1987?

Yes

No

Were you diagnosed with any of the following? (Select all that apply)*

Adult Leukemia

Aplastic Anemia of other Myelodysplastic Sydromes

Bladder Cancer

Kidney Cancer

Liver Cancer

Multiple Myeloma

Non-Hodgkin's Lymphoma

Parkinson's Disease

Isophageal Cancer

Breast Cancer

Renal Toxixity

Sclegoderma (Systemic Sclerosis)

Lung Cancer

Hepatic Steatosis (Fatty Liver Disease)

Miscarriage

Cardiac (heart related)

Birth Defect (In Utero ONLY)

Other Type of Cancer

Other Serious Medical Condition

None of the above, but being medically monitored for.

Do you currently, or have you ever smoked?*

Currently Smoke

Never Smoked

Smoked but quit

Are you currently represented by an attorney regarding anything to do with the Camp Lejeune Water Contamination?*

Yes

No

Name

First Last

Phone

Email

I like to stay informed, sign me up for Vmail!*

Yes

No

By submitting this form you are agreeing to be contacted by an attorney or other law firm staff.

Name

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Contact

First name*
First name
Last Name*
Last Name
Phone Number*
Email Address*
Message*
I like to stay informed, sign me up for Vmail!*
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- No
By submitting this form you are agreeing to be contacted by an attorney or other law firm staff.
Comments
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Moline, IL 61265

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Cedar Rapids, IA 52403

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Disclaimer: The information contained on this website is presented by VanDerGinst Law, P.C. – Injury Attorneys. It is not intended, nor should it be construed, as professional legal advice. The information is general in nature about the Firm, the scope of services we offer, and our community outreach, it is not legal advice. Please contact us by phone, email, mail, or via this website for inquiries. Contacting us does not create an attorney-client relationship. Please contact a personal injury attorney for a consultation regarding your situation. This website is not intended to solicit clients outside the State of Iowa and/or State of Illinois. Please review the Terms of Use and Privacy Policy.

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