necformulahelp.pages.dev
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URL:
https://necformulahelp.pages.dev/
Submission: On January 23 via api from US — Scanned from US
Submission: On January 23 via api from US — Scanned from US
Form analysis
1 forms found in the DOMName: email-form —
<form id="email-form" name="email-form" action="">
<div class="group__input required select">
<p>Was your child diagnosed with Necrotizing Enterocolitis (NEC)?</p>
<select id="NEC" name="NEC">
<option value="" selected="" disabled="" style="display:none;">--Select one--</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div class="group__input required select">
<p>Was your baby fed cow’s milk-based formula?</p>
<select id="infant_formula" name="infant_formula">
<option value="" selected="" disabled="" style="display:none;">--Select one--</option>
<option value="Yes">Yes</option>
<option value="No (baby was fed non-dairy / non-cow’s milk-based formula)">No (baby was fed non-dairy / non-cow’s milk-based formula)</option>
<option value="Not fed formula (baby was breastfed)">Not fed formula (baby was breastfed)</option>
</select>
</div>
<div class="group__input required select">
<p>Was your baby born prematurely (34 weeks or earlier)?</p>
<select id="born_premature" name="born_premature">
<option value="" selected="" disabled="" style="display:none;">--Select one--</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div class="group__input required short">
<p>First Name</p>
<input id="first_name" data-name="first_name" name="first_name" type="text">
</div>
<div class="group__input required short">
<p>Last Name</p>
<input id="last_name" data-name="last_name" name="last_name" type="text">
</div>
<div class="group__input required email">
<p>Email</p>
<input id="email_address" name="email_address" data-name="email_address" type="text">
</div>
<div class="group__input required phone">
<p>Phone Number</p>
<input id="phone_home" name="phone_home" data-name="phone_home" type="text" placeholder="(___) - ___ - ____">
</div>
<div class="group__input required short">
<p>Please briefly describe the circumstances surrounding the diagnosis:</p>
<textarea name="description" id="description" cols="30" rows="10"></textarea>
</div>
<input type="hidden" name="page_version" value="Lejeune Split">
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<input type="hidden" id="field-30" name="anura_response" value="bad" data-at="form-hidden-input">
<input type="hidden" id="field-31" name="efid" value="[efid]" data-at="form-hidden-input">
<input type="hidden" id="pageurl" name="pageurl" value="https://necformulahelp.pages.dev/" data-at="form-hidden-input">
<input type="hidden" id="ip_address" name="ip_address" value="96.9.249.42" data-at="form-hidden-input">
<div class="group__submit">
<button id="fsubmit" type="submit" disabled="disabled">Request my free evaluation</button>
</div>
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</form>
Text Content
When did you or a loved one live or work at Camp Lejeune? is required WAS YOUR CHILD DIAGNOSED WITH NECROTIZING ENTEROCOLITIS (NEC) AFTER BEING FED WITH COW'S MILK FORMULA? FAMILIES AFFECTED MAY BE ENTITLED TO COMPENSATION. HUNDREDS OF FAMILIES ARE TAKING THE FIRST STEPS TOWARDS POTENTIAL COMPENSATION. STEP 1: TAKE THIS EVALUATION Was your child diagnosed with Necrotizing Enterocolitis (NEC)? --Select one-- Yes No Was your baby fed cow’s milk-based formula? --Select one-- Yes No (baby was fed non-dairy / non-cow’s milk-based formula) Not fed formula (baby was breastfed) Was your baby born prematurely (34 weeks or earlier)? --Select one-- Yes No First Name Last Name Email Phone Number Please briefly describe the circumstances surrounding the diagnosis: Request my free evaluation CONFIDENTIAL REVIEW SECURE SITE Disclaimer: By clicking 'REQUEST MY FREE EVALUATION ', you are providing express written consent for CA Marketing and/or Total Injury Help to contact you via telephone, email, text, or short message services (including through automated means; e.g. autodialing, text and pre-recorded messaging) You are providing authorization to contact you on your home telephone, mobile device (including SMS and MMS) and/or email, even if your telephone number is currently listed on any state, federal, local or corporate Do Not Call lists and registries. Your consent to this agreement is not required to purchase products or services. Message and data rates may apply. WAS YOUR CHILD DIAGNOSED WITH NECROTIZING ENTEROCOLITIS (NEC) AFTER BEING FED WITH COW'S MILK FORMULA? Families affected may be entitled to compensation. DO NOT STOP TAKING A PRESCRIBED MEDICATION WITHOUT FIRST CONSULTING WITH YOUR DOCTOR. DISCONTINUING A PRESCRIBED MEDICATION WITHOUT YOUR DOCTOR'S ADVICE CAN RESULT IN INJURY OR DEATH. The medication(s) described on this page remains approved by the United States Food & Drug Administration (FDA). Please note: Completion of this evaluation does not guarantee compensation. Each project has specific qualifying criteria and the criteria may change from time-to-time. In some instances, users who are not immediately contacted may be contacted at a later date. Data Use Policy: The information you provide while taking this evaluation may be provided to an attorney or law firm representing clients in your area. An attorney or law firm may contact you by phone or text message regarding this matter. Select Justice, LLC will not provide your contact information to any unaffiliated third parties. STUDY: FORMULA-FED PREEMIES AT HIGHER RISK FOR DANGEROUS GI CONDITION THAN BABIES WHO GET DONOR MILK (SCIENCE DAILY, MAY 1, 2011) SEE IF YOU MAY QUALIFY FOR POTENTIAL COMPENSATION. Take this short, confidential evaluation now. REQUEST MY FREE EVALUATION This is a legal advertisement Attorney Advertising Disclaimer: The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. Prior results do not guarantee a similar outcome. * Privacy Policy * Terms and Conditions Submitting form please wait...