SG Website: Weight Loss Drug Survey

1

Are you an Illinois resident?* This field is required.

Yes

No

2

Do you work in Illinois?* This field is required.

Yes

No

3

What company or entity did/do you work for?* This field is required.

4

Are you a current or former employee?* This field is required.

Current

Former

5

Were you required to get a physical exam prior to employment?* This field is required.

Yes

No

6

During the physical exam, were you asked about your FAMILY’S medical history?* This field is required.

Yes

No

7

Were you asked about your family’s medical history in writing during the exam?* This field is required.

Yes

No

8

Did the physical exam take place sometime in the past 5 years (meaning sometime between 2019 – 2024)?* This field is required.

Yes

No

9

Thank you for completing this survey! Based on your responses, it appears that you may be eligible for SUBSTANTIAL COMPENSATION via the Genetic Information Privacy Act (GIPA)! To learn more at NO COST to you, fill out your contact information and a representative will be in touch.

10

What is your first and last name?* This field is required.

First Name

Last Name

11

What is your email?* This field is required.

example@example.com

12

What is your phone number?* This field is required.

Please enter a valid phone number.

13

Please verify that you are human* This field is required.