LAWSUITS NEWS & LEGAL INFORMATION

Soy Milk (causing infant leukemia)

Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersAndSettlements.com.

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Defendant:
(who caused the harm?)

*Describe your complaint:
(briefly describe the damages you have suffered)

Did You use soy based products while you were pregnant?

Yes No

If yes, which soy based products did you use?

Did you use these soy based products on a daily basis through the term of your pregnancy?

Yes No

Do you have receipts or credit card charges indicating the purchase of these soy based products?

Yes No

What is the date of birth of your child?

Was your child determined to be lactose intolerant after birth?

Yes No

Did you feed your child soy milk?

Yes No

If yes, which brand(s) of soy milk products did you feed your child?

At what age did you begin feeding your child soy milk?

For how long did you feed your child soy milk?

Do you have receipts or credit card charges indicating the purchase of soy milk?

Yes No

Did you feed your child soy based products other than soy milk?

Yes No

If yes, which brand(s) of soy based products did you feed your child?

At what age did you begin feeding your child soy based products?

For how long did you feed your child these soy based products?

Do you have receipts or credit card charges indicating the purchase of these soy based products?

Yes No

Has your child been diagnosed with Leukemia or Infantile Acute Leukemia (IAL)?

Yes No

If yes, where has your child received their primary medical treatment for this condition?

If yes, what was the date of such diagnosis?

If yes, what is their current condition?

Was there any genetic testing done of your child?

Yes No

If yes, what were the findings?

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*Last name:

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*Phone number(s):

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Best time & way to contact you:

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