Asbestos and Mesothelioma Contact Form

The latest statistics show that between 1980 and 2000, over 8,000 men and over 1,000 women died from Mesothelioma. If someone in your family has been affected by this grave disease, you may be legally entitled to financial compensation to help cover your losses.

Free Info About Mesothelioma Litigation

The lawyers of Rose, Klein & Marias believe that it is important to make certain that clients are educated about their cases.

If you or a family member has been diagnosed with mesothelioma, we encourage you to browse through the extensive information we have provided below. After doing so, please get in touch with us so we can offer you a free consultation about your unique situation.

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Asbestos and Mesothelioma Contact Form

*First Name

*Last Name

*Email Address

*Phone Number


Street Address


Incident Street Address

Incident Apt/Ste

*Incident Zip

When did you first have contact with asbestos?

Where were you when the contact occurred?

What were you doing when the contact occurred?

Who owns the property where the contact occurred?

How many times have you been exposed to asbestos?

Did you or your employer purchase the product that contained the asbestos?

Were you working at the time of the exposure? For whom?

If you encountered the asbestos at work, do you recall any training, warnings or provision of protective gear by your employer to protect you from or educate you about asbestos?

What disease or injury (mesothelioma, asbestosis, lung or other cancer) has occurred as result of the asbestos exposure?

Please list your treating physicians and other medical providers

Do you or have you smoked? How much and when?

When did you first receive treatment for the condition caused by the exposure?

What was your diagnosis? What is your diagnosis/prognosis today?

What type of treatment do you currently receive?

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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