Be a Part of a Broader Suit
All information shared below is confidential to America's Frontline Doctors. Your information will never be shared or sold. If your information meets the criteria for an upcoming case, we will contact you for additional information. There is no cost to you to participate in our broad litigation. If you decide to proceed with the case, you cannot do so anonymously, as your name will appear (with others) in the court proceedings. Thank you for being willing to take a stand for your health and our freedom!
Name
*
First Name
Last Name
Address
*
City
*
State
*
Please Select
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP Code
*
Cell Phone
*
Please enter a valid phone number.
Email
*
example@example.com
Age of Plaintiff
*
Please Select
Self- Adult over 18
Parent of a Minor
Self - Minor
Vaccine Mandated by which type of Organization?
*
Please Select
Public K-12 School
Private K-12 School
Childcare
Public University
Private University
Government Employer
Private Employer
Military
N/A
City of Legal Issue:
*
State of Legal Issue:
*
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Multiple State Selections Allowed
ZIP Code of Legal Issue:
*
Have you ever had Covid-19?
*
Yes
No
Evidence of Prior Covid-19?
*
PCR Test
Antibody Test
Symptoms
N/A
Which one best describes your role in this issue?
*
Student
Teacher
Doctor
Pharmacist
School Owner/Operator
Parent
Nurse
Childcare Owner/Operator
Military
Government Employee
Lawyer
Pilot
Other
Previous Medical History Related to Vaccines:
Do you have a health issue which you feel puts you at risk for taking the Covid Vaccine?
I’ve taken the Covid Vaccine and am experiencing adverse reactions or events?
You understand that you are submitting personal information related to your health that may be used in legal cases as a plaintiff. Your data will NEVER be shared, sold or rented.
*
I understand
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