Contact Information | Mesothelioma and Asbestos Center

Contact Us

At MAA Center we want to assist you in the best way possible. Please fill out the information below so that a representative may research your question or comment and respond to you within 24 hours. We'll even send you a FREE information booklet and Q&A book providing extended mesothelioma and asbestos information.

First Name:

Last Name:

Street Address:

Suite:

City:

State:

Phone (Home):

Phone (Work):

Phone (Cell):

Fax:

Email:

Zip Code:

Have you (or the party of concern) ever been officially diagnosed with:

Mesothelioma
Asbestos Related Lung Cancer
Have Not Been Diagnosed with Either

When were you (or the party of concern) officially diagnosed?

Would you like someone from our office to:

Send you mesothelioma treatment information
Follow up with a call or email
Schedule a time to meet with you

Are you currently represented by counsel in an Asbestos Claim?

Yes No

Please include any additional comments you might have. Please tell us more about you or the party of concerns situation including:

Date of birth?
Where did diagnosis and treatment of Mesothelioma occur?
Is the Party of Concern still alive? If not, when did he or she pass away?
Where did exposure to asbestos occur?
List occupation and jobsites worked at (shipyards, boiler rooms, powerhouses, etc.) where asbestos exposure occurred.
Can you recall any asbestos products or brand names that he or she worked with?

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