Humphrey, Farrington & McClain

These materials have been prepared by Humphrey, Farrington & McClain, P.C. for informational purposes only and are not legal or medical advice. Transmission of this information is not intended to create and its receipt does not constitute an attorney-client relationship between you and the firm. You should not act upon this information without first seeking professional legal or medical counsel.

You should not send any information to us until you have received written acceptance from the firm of any legal services you may request. The content of any correspondence you send via the Internet will not be considered confidential unless you have received this written confirmation.

Please address all questions and comments to webmaster@hfmlegal.com

Fields marked with an asterisk (*) are required

Name(*):
Street Address(*):
City(*):
State(*):
ZIP Code(*):
Telephone:
Fax:
E-mail address:
Are you writing on behalf of a relative or family member with asbestos disease or exposure?
Yes No
Have you ever been diagnosed with an asbestos-related disease?
Yes No
What was the diagnosis?

When did you receive the diagnosis?
Occupation/trade:
Places of employment Years of employment

Were you a union member? If so, what is the union and local # and your years of membership?

Describe your exposures to asbestos:

Do you possess any asbestos-containing products today? If so, what product?

Comments or additional questions