JCA: Class Action Quiz

Do you believe your incident involves a significantly large group of people?*

YesNo
What type of incident do you believe you fall under? *

Data Breach/PrivacyConsumer ProductsAutomotive Class ActionsMedical (Drug & Medical Device and/or Medical Malpractice)Environmental – Toxic TortEmployment

Medical (Drug & Medical Device and/or Medical Malpractice)
Were you injured by:*

A MedicationMedical MalpracticeA Medical Device
If you were injured by a medication, list the name and manufacturer of the medication involved in your incident?*
When did you first start taking the medication (month/year)?
When did you first start to experience adverse effects/onset of symptoms (month/year)?*
If you were injured by a medical device, list the name and manufacturer of the medical device involved in your incident?*
If injured by a medical device, when was the device implanted (month/year)? *
If injured by a medical device, when did you first start to experience adverse effects/onset of your symptoms?
If injured by a medical device, did you require a revision surgery/repeat surgery to correct the problem?*

YesNo
If you were injured by a health professional, list the hospital or healthcare facility where the incident occurred.*
What month and year did this incident occur?*
Give us a brief description of what happened.*
Have you contacted the manufacturer/medical staff regarding these concerns?*

YesNo
What was the month and year you notified them?*

You Do Not Qualify
We appreciate you reaching out to us, however, without proof of a data breach letter, we are unable to move forward with your case. If you receive a breach letter at a later time, please contact us at 772-SUE-THEM.

You Do Not Qualify
We appreciate your interest in working with Join Class Actions, however, we do not take cases from other attorneys. Please consider us for any future cases!

Thank You For Taking The Quiz!
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First Name*
Last Name*
Email*
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Phone Number*
Please enter a valid phone number.
Please verify that you are human*
Should be Empty:

Data Breach / Privacy