Be a Part of a Broader Suit

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 *
ZIP Code *
Cell Phone *
Please enter a valid phone number.
Email *
example@example.com
Age of Plaintiff *
Vaccine Mandated by which type of Organization? *
City of Legal Issue: *
State of Legal Issue: *
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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