Welcome from Milberg!

Thank you for your interest. Please fill out the following information for our team to review.

1. Were you or your child exposed to Dacthal, an herbicide that contains DCPA (dimethyl tetrachloroterephthalate)?

Yes – MeYes - My ChildYes – My child and INo

2. Did you experience any symptoms or were you diagnosed with any conditions?

YesNo

3. If your child was exposed and experienced symptoms, what is the name of your child?

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