Intake Form

Office address:

200 East Second Street, Pomeroy, Ohio 45769

Call for help:

(740) 992-6368

Email Us:

adam@taslg.com

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We encourage you to use the form below to share information with us that will help us determine how to help you.

Please use the form below to submit information relevant to your potential case.

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Please refer to our trades of interest and sites of interest, as necessary.

    First Name

    Last Name

    Your Email

    Telephone Number

    Who Are You Inquiring For?

    Was that person diagnosed with Lung Cancer or Mesothelioma?

    Was a diagnosis of Lung Cancer or Mesothelioma made within the last two years?

    Was a tissue biopsy performed?

    Did the person, or anyone in the person's household at the time, go to work before 1980?

    Did the person ever reside or work (for any length of time, even a few weeks) in the State of West Virginia?

    Has the person ever made a settlement for asbestosis? (This might not bar further settlement.)

    Was the person a member of a Union?

    Was the person a member of a Union?

    If so, please give the Local # and Location

    At what sites of interest did the person work? Where might the person have been exposed to asbestos?