CPAP
First Name
First Name
Last Name
Last Name
Email
Email
Phone
Phone
Have you suffered any of the following injuries as a result of using a CPAP, BiPAP or ventilator machine?
Head, neck, liver, lung, or kidney cancer
Damage to the kidneys, liver, or lungs
Other injury
Unsure
Not injured
Did you use a Philips brand machine?
Yes
No
Unsure
Did you seek medical treatment for your injury?
Yes
No
Unsure
Upload gov.id proof (.png, .jpg, .pdf)
*
Upload gov.id proof
Comments
Comments
By clicking the "SUBMIT" button below, I affirm that I am 13 years of age or older and provide my express written consent to receive autodialed and/or prerecorded telemarketing calls and text messages from
Lawsuit Support
at the telephone number I provided above, including my wireless number, if applicable. I understand that my consent is not a condition of service and that I may revoke my consent at any time by following the opt-out instructions provided in the communications. I have also read and agree to the
Privacy Policy
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