Do you believe that you or someone you know has been poisoned by malathion through personal use (as a pesticide or pediculicide/scabicide), a pest control/landscaping company, agriculture spraying, government spraying or on the job?

If so, please fill out the form below which is being forwarded to attorneys interested in gaining information in these types of incidents for potential lawsuits. 

 

Section I - Spraying by Third Party

How Poisoned? ...

  • Pest control/landscaping company you hired , 

  • Aerial or truck spraying by government (city, state or federal) or 

  • Spraying by local agriculture (farming application). 

Were you warned of intended spraying and advised of precautions to take and/or of hazards?:  

Yes   No

Are any other individuals in your home or neighborhood also having symptoms?:

Yes   No

Section II - Products Purchased by You

Name of Product:    

Place Purchased (Name of Store or Pharmacy):  

Date of Purchase (approximate okay):   

Was this for:  

  •   Indoor Use

  •   Outdoor Use

  •   Personal Use (i.e. Prescription for head lice, scabies, etc.): 

Do you believe you followed directions on the package:  Yes   No

General Information:

Place of Poisoning:    City:    State: 

Date of Poisoning (approximate okay):   

How long after exposure to malathion did symptoms begin: 

Did you seek medical assistance:  

Yes   No

Please provide a description of what happened:

First Name:      Last Name:

Address:
City:      State:    Zip: 

Phone: 
Email: 

Note:  No personal information will be shared or used without your permission.  Your comments will be forwarded to the attorneys and may be posted on the internet.  We will only use your "initials" and "state" to identify your comments. 

SELECT YES OR NO:

It is okay to contact me for further information: Yes   No

(please make sure your information is correct before submitting)

 
 

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