form.getrxsorted.com
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2600:9000:2120:a400:3:e084:2dc0:93a1
Public Scan
Submitted URL: https://iziezerzerrmeezmzero.s3.us-west-2.amazonaws.com/zarreazazrazerez.html#/redirect.html?od=1syoshort62740b6d52857_vl_intervl_0zx4.6y1w660.C2n9crhes...
Effective URL: https://form.getrxsorted.com/flow/injtort_survey/variant/injtort_survey_1?aff_id=8690_0006_5645_4356_3-ENTX690209%7C126129132...
Submission: On May 05 via api from BE — Scanned from US
Effective URL: https://form.getrxsorted.com/flow/injtort_survey/variant/injtort_survey_1?aff_id=8690_0006_5645_4356_3-ENTX690209%7C126129132...
Submission: On May 05 via api from BE — Scanned from US
Form analysis 1 forms found in the DOM
<form id="flow-renderer-root" class="FLkvMQGhtALf1_LPwocw AY3M8zM9oKbVMzfK9Xqp" style="transition: background-color 0.08s ease-in 0s; font-weight: 400; font-size: 1rem; font-family: Roboto;">
<div class="css-1hyoxmk e1rae3de1">
<div class="css-16u8xh">
<div style="grid-area: 1 / 2 / 2 / 3;">
<div class="css-4n9gkq">
<div class="Ow7sNRZo3IbET3Db6fnI" style="display: flex; justify-content: center;">
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; min-height: 50px; max-height: 90px; margin: 10px; opacity: 1;"><img class="KYjY6UffZ9Z7ROD0XUbH"
src="https://usercontent.formsort.com/AskLaw/f29fe6a8-8657-47f6-b70b-d1e0e513dbd0.png" alt="Logo" style="max-height: 90px; width: 100%;"></div>
</div>
</div>
</div>
</div>
</div>
<div class="VIy4kq6vd4tlF2qQV0p8">
<div class="css-rut65p" style="overflow: hidden;">
<div style="opacity: 1;">
<div class="G04ORU8Et3aW0a8zYAlg CasHoy0sN7XxOryQRn4i" data-qa-content-inner="true" style="padding: 10px;">
<div style="margin-left: auto; margin-right: auto; width: 100%; max-width: 800px;">
<div class="css-zg1vud elhmfpg0">
<div data-testid="FLOW_STEP_LABEL" class="css-4zi6ej elhmfpg1">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA css-sujtal">
<h2 id="billions-in-compensation-paid-out-already" style="font-weight: 800; font-size: 1.5rem;">Billions in compensation paid out already...</h2>
</div>
</div>
<div class="css-14ee9u7">
<div style="flex: 12 1 0%; margin-top: 16px; margin-right: 16px; z-index: 0; max-width: 100%;">
<div class="rah-static rah-static--height-auto" data-testid="FLOW_QUESTION" aria-hidden="false" style="height: auto; overflow: visible;">
<div style="transition: opacity 200ms ease 0ms;">
<div style="transform: translateX(0px); opacity: 1;">
<div>
<div class="css-0">
<div style="transform: translateX(0px); opacity: 1;">
<fieldset data-qa-answer-type-label="tort_offerwall" style="position: relative; text-align: center; padding: 16px 0px; border-width: 0px; border-style: solid;">
<div style="margin-left: auto; margin-right: auto;">
<legend id="q-label-7ef66aa7-7383-4fe6-8f31-d46caad4ec9c" data-testid="FLOW_QUESTION_LABEL" for="7ef66aa7-7383-4fe6-8f31-d46caad4ec9c"><span class="css-1i0glk5" style="margin: 0px 0px 4px;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<h3 id="which-of-the-following-best-describes-your-situation-you-can-select-more-than-one" style="font-weight: 800; font-size: 1.17rem;">Which of the following best describes your situation? (you can select
more than one)</h3>
</div>
</span></legend>
<div class="css-1jke4yk">
<div class="css-4l27bf vertical checkmark">
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="4f10b3ab-9b9c-485f-8d55-1013e28fd29b" type="button" value="4f10b3ab-9b9c-485f-8d55-1013e28fd29b" data-qa-value="auto_injury"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I was injured in an Auto Accident</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="52a6009d-2582-45c2-8608-77ff1dae97fb" type="button" value="52a6009d-2582-45c2-8608-77ff1dae97fb" data-qa-value="roundup"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Roundup & Have Lymphoma</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="0c89dfde-1873-46fe-b9a3-ebae589386cf" type="button" value="0c89dfde-1873-46fe-b9a3-ebae589386cf" data-qa-value="talcum"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Talcum Powder & Have Ovarian Cancer</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="192a79f4-db86-4524-8c74-4c1f11577359" type="button" value="192a79f4-db86-4524-8c74-4c1f11577359" data-qa-value="zantac"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Zantac & Have Cancer</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="375505ab-e91e-4ce1-8794-2c371f39d68b" type="button" value="375505ab-e91e-4ce1-8794-2c371f39d68b" data-qa-value="3m"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used 3M Hearing Plugs in Military and have hearing issues</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="693afbd6-20b2-44cc-83da-dd19bbf6773a" type="button" value="693afbd6-20b2-44cc-83da-dd19bbf6773a" data-qa-value="hernia"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Had Hernia Mesh Complications</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="23bd4320-0f0d-4146-a286-acc6883c3cef" type="button" value="23bd4320-0f0d-4146-a286-acc6883c3cef" data-qa-value="clergy_inst_abuse"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I was sexually abused by clergy member/school/club/institution</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="718b5f2b-c442-4487-b885-97fc9a2ac753" type="button" value="718b5f2b-c442-4487-b885-97fc9a2ac753" data-qa-value="uber_abuse"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Sexually abused by Uber or Lyft driver</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="bc1ad4b3-32b6-400e-b9a7-e1373bcd56f4" type="button" value="bc1ad4b3-32b6-400e-b9a7-e1373bcd56f4" data-qa-value="paraquat"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Paraquat and have Parkinson's</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="3288f5d5-afc5-48e7-8811-e05ec8e7369a" type="button" value="3288f5d5-afc5-48e7-8811-e05ec8e7369a" data-qa-value="elmiron"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Elmiron bladder medication and had vision problems</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="69a6e637-5e6e-4b89-9728-4e2b107eecea" type="button" value="69a6e637-5e6e-4b89-9728-4e2b107eecea" data-qa-value="truvada"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Truvada for HIV causing Bone or Kidney Issues</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="73ff55ce-392b-48e7-99cc-e9973d616363" type="button" value="73ff55ce-392b-48e7-99cc-e9973d616363" data-qa-value="pi"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I was injured and need a lawyer</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="d3c6e2fd-8d7b-4aa4-a5c0-782571ca1cf7" type="button" value="d3c6e2fd-8d7b-4aa4-a5c0-782571ca1cf7" data-qa-value="cpap"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Used Philips CPAP and have cancer or organ issues</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="321d4312-9b4b-4d5b-9883-eaff82a3c43d" type="button" value="321d4312-9b4b-4d5b-9883-eaff82a3c43d" data-qa-value="railroad"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Worked on the Railroad and have cancer</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="027146d3-ce76-4428-8ccd-2afab3154c92" type="button" value="027146d3-ce76-4428-8ccd-2afab3154c92" data-qa-value="nec"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Had a baby diagnosed with Necrotizing Enterocolitis (NEC)</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="a61d99d0-2cef-43ac-ac65-479cbf0fafc9" type="button" value="a61d99d0-2cef-43ac-ac65-479cbf0fafc9" data-qa-value="asbestos"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Exposed to Asbestos and have cancer</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="d6abee4c-68ea-4432-a2e5-de824b1041c4" type="button" value="d6abee4c-68ea-4432-a2e5-de824b1041c4" data-qa-value="lung_cancer"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I have lung cancer (you may be owed compensation)</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="80edba82-ffa0-4496-9d4f-b09a5892e2ec" type="button" value="80edba82-ffa0-4496-9d4f-b09a5892e2ec" data-qa-value="exactech"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I have an Exactech knee, hip, or ankle replacement</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="a21281e1-e5d2-43f8-8239-5a94d2829fed" type="button" value="a21281e1-e5d2-43f8-8239-5a94d2829fed" data-qa-value="clinical_trials"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">Get paid up to several thousand dollars for participating in clinical trials in your area</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="a8d786a9-16a2-4bb0-9fca-30cdba80084f" type="button" value="a8d786a9-16a2-4bb0-9fca-30cdba80084f" data-qa-value="credit_card_debt"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I'm overwhelmed by credit card debt and need help</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="bd315b1b-2216-4bba-96b0-ded39ed7adb5" type="button" value="bd315b1b-2216-4bba-96b0-ded39ed7adb5" data-qa-value="general_legal"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">I have a different legal issue</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="500c0883-01e6-4bff-a491-cbe1ea1dbfce" type="button" value="500c0883-01e6-4bff-a491-cbe1ea1dbfce" data-qa-value="financial_help"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">No legal issue, but need financial help</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
<div class="css-0 checkmark"><button class="az96MHpkTYkl9JkeCf6h" name="67a4eddf-268b-4086-b4f7-8763cfc8be84" type="button" value="67a4eddf-268b-4086-b4f7-8763cfc8be84" data-qa-value="none_above"
style="display: flex; flex-direction: row-reverse; align-items: center; justify-content: center; text-align: center; background-color: rgb(255, 255, 255); color: rgb(17, 21, 34); border-radius: 4px; border-color: rgb(220, 223, 232); border-width: 2px; box-shadow: rgba(0, 0, 0, 0.1) 0px 2px 4px; min-width: 200px; max-width: 300px; margin: 8px 0px; padding: 20px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">
<div class="YC3iXhQYxhoRrQPiwq6G KmT_5rCYV4Um7HUeBJqA vm4YMZVz0deNIFD3UbQP css-sujtal">
<p style="font-weight: 400; font-size: 1rem;">None of the above</p>
</div>
<div class="auEw5jGXJfaSCGmuiroe" style="border-radius: 0px; max-width: 200px; max-height: 200px; margin: 10px; opacity: 1; flex-grow: 0; flex-shrink: 0;">
<div role="checkbox"
style="display: inline-block; position: relative; border-style: solid; background-color: rgb(255, 255, 255); flex-shrink: 0; flex-grow: 0; width: 16px; height: 16px; border-color: rgb(17, 21, 34); border-radius: 2px; border-width: 2px; margin: 2px;">
</div>
</div>
</button></div>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="rah-static rah-static--height-zero" aria-hidden="true" style="height: 0px; overflow: hidden;">
<div style="transition: opacity 200ms ease 0ms; opacity: 0; display: none;"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div></div>
</div>
<div style="height: 65px;"></div>
</div>
</div>
</div>
<div data-qa-action-bar="true" class="css-14g86z4">
<div class="css-1hyoxmk e1rae3de1" style="padding-right: 10px; padding-bottom: 10px; padding-left: 10px;">
<div class="css-11365ok">
<div style="grid-area: 1 / 2 / 2 / 3;">
<div class="css-4n9gkq">
<div style="opacity: 1; height: auto; transition: opacity 250ms ease-in-out 0s;">
<div style="margin-left: auto; margin-right: auto;"><button class="az96MHpkTYkl9JkeCf6h" type="submit" disabled=""
style="font-size: 16px; font-family: Roboto; font-weight: 900; display: flex; flex-direction: row; align-items: center; justify-content: center; text-align: center; background-color: rgb(130, 136, 160); color: rgb(17, 21, 34); border-radius: 4px; border-width: 1px; min-width: 200px; max-width: 300px; padding: 16px 24px; flex: 1 1 1px; transition: all 0.08s ease-in-out 0s;">Next</button>
</div>
</div>
</div>
</div>
<div style="grid-area: 2 / 1 / 3 / 4;">
<div class="css-4n9gkq">
<div style="width: 100%; text-align: center; padding: 0px;">
<div class="rvKDqjg8e6cEw_jAny81">
<div role="progressbar" aria-label="form progress" aria-valuenow="1" aria-valuemin="1" aria-valuemax="8" class="B3xpAAhMy1Ecavhz9l6E" style="background-color: rgb(220, 223, 232); border-radius: 1px;">
<div class="JxNroE2M8TC0ZVGc4kgg" style="background-color: rgb(17, 21, 34); width: calc(0% + 2px); border-radius: 1px; height: 2px; transition: width 250ms ease-in-out 0s;"></div>
</div>
</div>
</div>
</div>
</div>
<div style="grid-area: 1 / 1 / 2 / 2;">
<div class="css-4n9gkq">
<div>
<div data-testid="previous-button-container" style="margin-right: auto;">
<div class="rah-static rah-static--height-zero" aria-hidden="true" style="height: 0px; overflow: hidden;">
<div style="transition: opacity 200ms ease 0ms; opacity: 0; display: none;"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</form>Text Content
You need to enable JavaScript to run this app. BILLIONS IN COMPENSATION PAID OUT ALREADY... WHICH OF THE FOLLOWING BEST DESCRIBES YOUR SITUATION? (YOU CAN SELECT MORE THAN ONE) I was injured in an Auto Accident Used Roundup & Have Lymphoma Used Talcum Powder & Have Ovarian Cancer Used Zantac & Have Cancer Used 3M Hearing Plugs in Military and have hearing issues Had Hernia Mesh Complications I was sexually abused by clergy member/school/club/institution Sexually abused by Uber or Lyft driver Used Paraquat and have Parkinson's Used Elmiron bladder medication and had vision problems Used Truvada for HIV causing Bone or Kidney Issues I was injured and need a lawyer Used Philips CPAP and have cancer or organ issues Worked on the Railroad and have cancer Had a baby diagnosed with Necrotizing Enterocolitis (NEC) Exposed to Asbestos and have cancer I have lung cancer (you may be owed compensation) I have an Exactech knee, hip, or ankle replacement Get paid up to several thousand dollars for participating in clinical trials in your area I'm overwhelmed by credit card debt and need help I have a different legal issue No legal issue, but need financial help None of the above Next