Baby's Full Name

Email

Phone

Home Address

Father's Date of Birth

Mother's Date of Birth

What is the best way to contact you?

Has your child been diagnosed with Autism Spectrum Disorder (ASD) (level 1, 2, or 3)?

Yes No

What Brand(s) of Baby Food Products have you used?

Beech-Nut Gerber Earth’s Best Organic Food Products (Hain Celestial) HappyFAMILY, HappyBABY – (Nuture, Inc) Plum Organics Sprout Organic Food Parent’s Choice FOOD Products (Walmart) Other – please explain

Explain what brand(s) of baby food products you have used (if not listed above)

How often and for how long have you used these products?

Where did you typically purchase these products (i.e., store name)?

What is the name of the hospital and address where your child was born?

What is the name of your ASD diagnosing physician

What is your child’s birthdate?

Any other relevant information you think we should know?

How did you hear about Carter Law Group?

Toxic Baby Food Lawsuit Intake Questionnaire

Contact Us

Amy Carter, Managing Shareholder

Heather Davis, Attorney

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