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www.paraquatinjuryclaims.com Open in urlscan Pro
107.178.254.45  Public Scan

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Submitted URL: https://hbn21hyt5jtu.blob.core.windows.net/hbn21hyt5jtu/hbn21hyt5jtu.html#qs=r-agjibajghdfchkgafbcdfgbahchibbkafbighafbighababaceaddaccadbc...
Effective URL: https://www.paraquatinjuryclaims.com/?requestid=6167573aa4642&s1=360055&s2=40756_6167009_11&s3=&s4=&s5=305142590&affid=32
Submission: On October 13 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST 

<form novalidate="" class="form email-form contents form-labels-outside-top" method="post" data-id="element-352" data-at="form" action-xhr="https://d.fastcdn.co/submissions" data-nb-form="0fec4af7-556e-4fdd-ae6c-690c491c3786">
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-0" data-at="form-select-title">Were you or a loved one exposed to Paraquat or Gramoxone?</label>
  <div class="form-block-select">
    <select id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-0" class="form-input form-select required  form-input-inner-shadow " data-at="form-select" name="Were you or a loved one exposed to Paraquat or Gramoxone?"
      data-describedby="form-validation-error-box-element-352" title="Were you or a loved one exposed to Paraquat or Gramoxone?" required="" aria-required="true">
      <option class="hidden" value="" disabled="" selected="">-- Select one--</option>
      <option class="form-select-option" value="Yes, directly exposed" data-at="form-select-option">Yes, directly exposed</option>
      <option class="form-select-option" value="Possibly exposed, I live near farm land" data-at="form-select-option">Possibly exposed, I live near farm land</option>
      <option class="form-select-option" value="Responding for a loved one" data-at="form-select-option">Responding for a loved one</option>
      <option class="form-select-option" value="No" data-at="form-select-option">No</option>
    </select>
  </div>
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-1" data-at="form-select-title">Do you or a loved one suffer from any symptoms of Parkinson’s Disease such as tremors?</label>
  <div class="form-block-select">
    <select id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-1" class="form-input form-select required  form-input-inner-shadow " data-at="form-select" name="Do you or a loved one suffer from any symptoms of Parkinson’s Disease such as tremors?"
      data-describedby="form-validation-error-box-element-352" title="Do you or a loved one suffer from any symptoms of Parkinson’s Disease such as tremors?" required="" aria-required="true">
      <option class="hidden" value="" disabled="" selected="">-- Select one--</option>
      <option class="form-select-option" value="Diagnosed with Parkinsons" data-at="form-select-option">Diagnosed with Parkinsons</option>
      <option class="form-select-option" value="Symptoms only" data-at="form-select-option">Symptoms only</option>
      <option class="form-select-option" value="No" data-at="form-select-option">No</option>
    </select>
  </div>
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-2" data-at="form-text-title">First Name</label>
  <input id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-2" class="form-input form-input-text required form-input-inner-shadow " data-at="form-text" type="text" name="First Name" data-describedby="form-validation-error-box-element-352" value=""
    title="First Name" placeholder="" data-label-inside="First Name" required="" aria-required="true">
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-3" data-at="form-text-title">Last Name</label>
  <input id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-3" class="form-input form-input-text required form-input-inner-shadow " data-at="form-text" type="text" name="Last Name" data-describedby="form-validation-error-box-element-352" value=""
    title="Last Name" placeholder="" data-label-inside="Last Name" required="" aria-required="true">
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-4" data-at="form-text-title">Phone Number</label>
  <input id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-4" class="form-input form-input-text required form-input-inner-shadow form-input-mask" data-at="form-text" type="text" name="Phone Number" data-describedby="form-validation-error-box-element-352"
    value="" title="Phone Number" data-mask="(000) - 000-0000" pattern="[0-9]*" inputmode="numeric" placeholder="" data-label-inside="Phone Number" required="" aria-required="true">
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-5" data-at="form-email-title">Email</label>
  <input id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-5" class="form-input form-input-text required form-input-inner-shadow " type="email" name="Email" data-describedby="form-validation-error-box-element-352" value="" title="Email"
    data-label-inside="Email" data-at="form-email" placeholder="" required="" aria-required="true" data-nb-id="0fec4af7-556e-4fdd-ae6c-690c491c3786">
  <label class="form-label-title form-label-outside form-label" for="field-a8a9fb2aa139fe14426a9fbbdd8a9715-6" data-at="form-textarea-title">Briefly describe what happened (optional)</label>
  <div class="form-block-textarea">
    <textarea id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-6" class="form-input form-textarea  form-input-inner-shadow " data-at="form-textarea" name="Briefly describe what happened (optional)" data-describedby="form-validation-error-box-element-352"
      title="Briefly describe what happened (optional)" placeholder="" data-label-inside="Briefly describe what happened (optional)" aria-required="false" maxlength="250"></textarea>
  </div>
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-7" name="requestid" value="6167573aa4642" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-8" name="s1" value="360055" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-9" name="s2" value="40756_6167009_11" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-10" name="s3" value="" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-11" name="s4" value="" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-12" name="s5" value="305142590" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-13" name="mediabuy" value="[mediabuy]" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-14" name="utm_campaign" value="[utm_campaign]" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-15" name="fb_adset_id" value="[fb_adset_id]" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-16" name="utm_content" value="[utm_content]" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-17" name="utm_medium" value="[utm_medium]" data-at="form-hidden-input">
  <input type="hidden" id="field-a8a9fb2aa139fe14426a9fbbdd8a9715-18" name="utm_source" value="[utm_source]" data-at="form-hidden-input">
  <input type="hidden" name="zapier2-integration"
    value="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"
    data-at="form-hidden-input">
  <input type="hidden" name="lpsSubmissionConfig"
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Were you or a loved one exposed to Paraquat or Gramoxone?
-- Select one-- Yes, directly exposed Possibly exposed, I live near farm land
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PARKINSON'S PATIENTS


WERE YOU EXPOSED TO PARAQUAT/GRAMOXONE? IF SO, YOU COULD BE ENTITLED TO
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AS SEEN ON:




THE PARAQUAT/GRAMOXONE & PARKINSON’S CONNECTION




• IN 2011 THE FARMING AND MOVEMENT EVALUATION (FAME) STUDY WAS RELEASED THAT
INVESTIGATED THE RELATIONSHIP BETWEEN PARKINSON’S & PESTICIDES 
• THE STUDY DETERMINED PARAQUAT USERS DEVELOPED PARKINSON’S 2.5 TIMES MORE OFTEN
THAN NON-USERS
• PARAQUAT IS ALREADY BANNED IN SEVERAL COUNTRIES INCLUDING EUROPE, SWITZERLAND,
AND CHINA HAS BEEN PHASING IT OUT SINCE 2012

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