Exposures – National Claims

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Comments

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Were you or a loved one ever exposed to any of these products? (Choose all that apply.)*

Asbestos

Silica / Stone Dust

Baby Powder / Talcum Powder

Fracking

Weed Killer (Roundup / Paraquat / Glyphosates )

Occupational / Workplace Exposure – Hair Dyes (Licensed Hair Stylists / Cosmetologists)

Personal / Consumer Use – Hair Dyes (At Home or as a Salon Customer)

Depo-Provera

Unsure

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diagnosis