JUUL Intake Form

Get help at no cost: Fill out the form below to see if you are eligible to join. If you qualify, an attorney will contact you to discuss the details of your potential case at no charge to you.

E-mail any problems with this form to: help@lifewallet.com

Name *

First

Middle

Last

Date of birth

Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

Email *

Are you a current or former JUUL user?YesNo

Have you experienced physical, emotional, or behavioral symptoms associated with JUUL use, including addiction?YesNo

Have you experienced any health problems due to JUUL usage?YesNo

Please state what health problems you have experienced.

Submit

You qualify for a claim.  To hire an attorney to represent you in this matter, click below to view the engagement agreement or click on the chat box to chat with an attorney. 

NOTE: If you do not qualify for this type of lawsuit do NOT file a claim. Remember: you are submitting your claim under penalty of perjury. You are also harming others eligibility by submitting a fraudulent claim. If you don’t qualify for this settlement, check out our database of other open causes of action you may be eligible for.