Please provide the requested information for each person claiming a chemical exposure related injury as a result of the chemical release at the BP Texas City refinery in April and May 2010. You must answer every question that is asked. You cannot leave any blanks. The on-line form allows for you to discontinue the form to gather information (such as dates of doctor visits, etc). You may then log back on and continue your form at a later time.

                  A separate Plaintiff Fact Sheet must be completed for each individual making a claim. For example, a parent must complete a separate form for each minor child and a personal representative must complete a separate form for each deceased person.

                       This “Plaintiff Fact Sheet” form is not a contract. It is a form that documents your claim. It is only intended for clients that currently have a signed contract with this firm. You must have a signed contract with this firm to be represented and your claims pursued. Filling out this form alone will not result in your claim being made or preserved.