--> Breast Implant Class Action CONTACT FORM

The independent claims office that will handle the processing and payment of claims in the Dow Corning bankruptcy case is now operational. In order to protect your legal rights, there may be certain forms you need to file now, even before the final confirmation. 

Please fill out the contact form if you received Breast implants between 1965-June 1,1993, as you may be eligible to participate in the Dow Corning and/or MDL 926 class actions.

If you did not receive implants during this time period, you may want to contact a product liability attorney or the corporation that manufactured your implants.

If you would like to know what legal rights you are entitled to, at no cost, please fill out the following form.

INFORMATION ABOUT YOU:

NAME:

ADDRESS: (Optional)

PHONE NUMBER: (Optional)

E-MAIL:

BREAST IMPLANT QUESTIONS:
Approximate Date of 1st Breast Implant Surgery:

 

Brand Name of 1st breast implant

 

Implant Model Number :

 

Implant Lot Number:

 

Do you have "Proof" of the brand of implant you received?

 

If so, what type of proof? (Example, copy of surgery report that lists brand, letter from doctor, etc.

 

Have one or more of your implants been removed?

 

Date Implant Removed

 

Did you receive new implants?

 

If so, what was brand of implant?

 

"Do you have proof of this implant?"

 

Have any of your implants ruptured?

 

If so, what Implant Brand Ruptured?

List other implant surgeries if applicable and the brand of implant.

Have you registered with the earlier MDL-926 Class Action?

If so, did you receive any money and how much?

Have you registered with the Dow Corning Class Action?

If so, has your Dow proof been accepted?

 

If so, did you receive any money and how much?

 

Do you have an existing attorney?:

Have you noticed any of the symptoms listed on the right, after you received your breast implants? 

Check all that apply:

Arthritis
Breast Deformity
Chills/Sweats
Depression
Fever
Hair Loss
Headaches
Joint Pain
Low Disease Resistance
Memory Loss
Muscle Weakness
Weight Gain
Weight Loss
None
Have you ever been treated for any of the above?:
Are you having any unexplained symptoms that you are concerned about?
Are you having problems with the claims board? If yes, please explain.

Any other information you would like to tell me that you feel is important?

  Please contact me as soon as possible regarding this matter.

Upon submitting this form, you certify that all of the information given is true and correct to the best of your knowledge. I/We understand that all The Law Offices of Stephen M. Frailich is agreeing to at this time is to look at our case and that by completing, filling out, and submitting this form to The Law Offices of Stephen M. Frailich, no Attorney-Client relationship is yet formed.

* PLEASE hit the SUBMIT button ONE TIME only *




PERSONAL COMMENTARY

05/10/06

It has been over one year since my last commentary, and a lot has happened in that one year in the Dow Corning Class Action. We have a new Claims Administrator, a major legal battle will be coming to a head before Judge Hood as it pertains to the denial of Level A claims, some deadlines have been extended once again, claims are being denied, claims are being paid, and claimants who have been waiting for their settlements over 13 years have been dying.

Read more Personal Commentary..


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