JOIN THE ACTION

By submitting the form, your case will be evaluated by our local speaking team and you will be contacted for follow-up and your potential participation in the lawsuit, or to provide any additional information needed.

First name

Last name

Email

Phone fix or mobile

Date of Birth

Country of Residence

Have you been using one of the recalled products?

Yes

No

Please select the model from the list

Year of first use

Year of last use

Do you have the memory card (SD or microSD or other) of your medical device or have you saved a backup?

Yes

No

In case of mechanical ventilators (no sleep apnea devices): have you ever been prescribed the use of one of such breathing devices at home or at a medical facility?

Yes

No

Are you suffering from a medical condition, illness, or injury that might have been cause by the use of the recalled devices?

Yes

No

If you answered Yes above please select below:

Cancer

Respiratory illness

Other

Have you ever received a recall letter regarding any such devices?

Yes

No

Are you a relative (e.g. mother/father, bother/sister) to a person that has been using a recalled product?

Yes

No

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