Start the claim process

The process for starting a claim for mesothelioma, silicosis or other dust disease is quite straight forward.

Please complete the information form below. If you don’t know any of the answers, just leave them blank.

All information is coinfidential.

We will be in touch shortly to confirm your details and to progress your claim.

We will issue you our retainer agreement, which sets out our obligations and no win no fee structure. There is no obligation to proceed with the claim until you have reviewed and agreed to this document.

Name

Phone

Date of Birth

Street Address

State

City

Country

What condition have you been disease have you been diagnosed with?

Have you made an application to the Dust Diseases Authority?

Yes No

What is the name of your treating doctor?

Do you know where you were exposed to the substance that caused the conditon?

Yes No

Provide any further details you may have

Upload any medical orm other records

Start the claim process