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The poisoning of Beverly Hills High

Jewish Journal of Greater Los Angeles - The classic one is asbestos exposure, and mesothelioma (a cancer of the lining of the lung), which my dad got from smoking Kents with a filter. My dad died in 1996. JJ: Was that part of the motivation for your book? JH: It's part of who I am. My mother ...
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PERSONAL INFORMATION
First Name:*
Last Name:*
E-mail Address:*
Home Phone: -- ext.
Address:
City:
State:*
Zip Code:

CASE INFORMATION
Have you been diagnosed with Mesothelioma?: Yes No
Date of Diagnosis:
Do you have a relative Diagnosed with Mesothelioma?: Yes No
Do you have a Pathology Report?: Yes No
Marital Status:
Number of Children:
Are you working with an Attorney?: Yes No
In which US state or states were you exposed?:
Case Description:
This form is secure and encrypted. More information about secure forms and your privacy here.