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FLINT, MICHIGAN LEADED WATER CLASS ACTION CASES QUESTIONNAIRE :
If you were a Flint, Michigan water user since April 2014, when the city of Flint started using Flint River water, please provide the following information. This is an Attorney-Privileged Document.
1. Your name.
2. Your Address.
3. Your telephone number.
4. Your email address.
5. Your age and birth date.
6. List the names and ages of other persons in your household.
7. Check the following issues that you believe may apply to you or your family as a result of exposure to Flint River water since April 2014:
- I or my family tested positive for lead in my/our blood.
- Our family water tested positive for lead.
- My children have developed behavior or educational problems in school.
- Skin rashes or other skin problems.
- Hair loss.
- Digestive problems.
- Infections (virus, bacteria, etc.).
-Breathing problems.
- Cognitive (mental), emotional or psychological problems.
- Liver or kidney disease.
-High blood pressure.
- Pregnancy problems.
- Aggravated medical condition due to lead exposure.
- Loss of property value.
- Property damage or economic damages (such as damage to water pipes, purchase of bottled water, etc.)
- Other issues.
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