/* growform client2 bundle.url: https://assets.growform.co/cee2d99-mhw6hzfz/form.bundle.js resolve.source: kv resolve.at: 2025-11-13T03:14:23.735Z form.source: kv cache.age_ms: 0 kv.value_present: true fallback_used: false */ ;(function () { var EMBED_TYPE = "iFrame"; var FORM_ID = "67851d6fb60c39000be0015d"; var FORM_BUNDLE_URL = "https://assets.growform.co/cee2d99-mhw6hzfz/form.bundle.js"; // injected by worker (KV/memory/fallback) var FORM_DATA = {"data":{"form":{"_id":"67851d6fb60c39000be0015d","steps":[{"id":"27eb4a1b1b082ade23f4559e","name":"Welcome page","sortOrder":1},{"id":"af638305e346fdec5af8ebad","name":"Paraquat exposure","sortOrder":2,"copyOf":"acd45227cac332d443c4e1db"},{"id":"ba6ec8141909e66202676ea2","name":"Paraquat indirect exposure","sortOrder":3,"copyOf":"af638305e346fdec5af8ebad","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"1d157d166ec02c7dc610f570"}]}]}},{"id":"acd45227cac332d443c4e1db","name":"Injury","sortOrder":4},{"id":"ff4727c9498ef9c0a6c989d9","name":"Symptoms","sortOrder":5,"conditionalLogic":null},{"id":"797dc88f8c77406fba2b6429","name":"Occupation","sortOrder":6,"copyOf":"ff4727c9498ef9c0a6c989d9","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"192368f189795a7f9199624d"}]}]}},{"id":"88ab832fa58d45caadba1f29","name":"Frequency","sortOrder":7,"copyOf":"797dc88f8c77406fba2b6429","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"192368f189795a7f9199624d"}]}]}},{"id":"fadba8819fe0505b9cb9f326","name":"Attorney","sortOrder":8,"conditionalLogic":null},{"id":"c6713a0fe5299542239f8a90","name":"Attorney Mismatch","sortOrder":9,"conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_861829943747678","operator":"selected_option","criteria":"833967cf9a728253200929a9"}]}]}},{"id":"8738f58293daa382ea86e475","name":"Contact details","sortOrder":10,"conditionalLogic":null}],"formName":"Paraquat","fields":{"Decorative Header_52363373085874":{"type":"Decorative Header","value":"We'll get started on your Free Case Review right away!","width":12,"step":"complete","sortOrder":1,"fieldStyle":{"fontSize":{"value":19,"unit":"px"},"fontWeight":"Bold"},"margins":{"marginTop":20},"stepId":"complete"},"Decorative Header_797442086161467":{"type":"Decorative Header","value":"Have you (or a loved one) been diagnosed with Parkinson's disease?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"acd45227cac332d443c4e1db","margins":{"marginBottom":0}},"Decorative Header_576559560634956":{"type":"Decorative Header","value":"Do you or a loved one experience symptoms of Parkinson’s Disease, such as tremors?","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"ff4727c9498ef9c0a6c989d9","margins":{"marginBottom":0}},"Decorative_Paragraph_194067845817258":{"type":"Decorative Paragraph","value":"This is what will happen now:\n\n1. You'll be contacted by one of our legal partners to start your Free Case Review\n\n2. Hand over the required documentation as soon as possible to increase the chance of success\n\n3. If all details are correct, we'll fight on your behalf for the highest compensation possible. This is completely risk-free.","width":12,"step":"complete","sortOrder":2,"margins":{"marginBottom":60},"stepId":"complete","fieldStyle":{"lineHeight":"190%"}},"buttons_109446974978914":{"type":"Buttons","validationRules":{"required":true},"label":"Injury","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"Yes","id":"192368f189795a7f9199624d"},{"text":"No","image":null,"id":"70c0a9378e749251d6da0647"}],"stepId":"acd45227cac332d443c4e1db","sortOrder":2,"hideLabel":true},"decorative_header_235172494296605":{"type":"Decorative Header","value":"Parkinson’s Disease Linked to Paraquat? Find out if you qualify for Significant Financial Compensation.","width":12,"sortOrder":1,"stepId":"27eb4a1b1b082ade23f4559e","fieldStyle":{"fontSize":{"value":25,"unit":"px"}}},"decorative_paragraph_61751321477965":{"type":"Decorative Paragraph","value":"Completing this form only takes a minute of your time and is completely risk-free. After filling in the form, we will check if you are eligible for a financial compensation.","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":2,"fieldStyle":{"fontSize":{"value":16,"unit":"px"}}},"decorative_header_656607592367283":{"type":"Decorative Header","value":"Based on your information, you likely qualify for Significant Financial Compensation in the Paraquat Lawsuit.","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"}}},"decorative_paragraph_157556002269067":{"type":"Decorative Paragraph","value":"Enter your contact details below to get a Free Case Review. This is completely confidential.","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":2,"fieldStyle":{"fontSize":{"value":18,"unit":"px"}}},"decorative_header_894193740805577":{"type":"Decorative Header","value":"Have you signed with an attorney for this lawsuit?","width":12,"stepId":"fadba8819fe0505b9cb9f326","sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"}}},"decorative_paragraph_260567631866786":{"type":"Decorative Paragraph","value":"In order to qualify for a Free Case Review, we need to make sure that you are currenly not already represented for this case.","width":12,"stepId":"fadba8819fe0505b9cb9f326","sortOrder":2,"fieldStyle":{"fontSize":{"value":20,"unit":"px"}}},"buttons_861829943747678":{"type":"Buttons","validationRules":{"required":true},"label":"Attorney","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"No, I'm currently not represented by an attorney","id":"d8a04793f71f8079aa557592"},{"text":"I'm already represented by an attorney","id":"833967cf9a728253200929a9"}],"stepId":"fadba8819fe0505b9cb9f326","sortOrder":3,"hideLabel":true},"text_415843839585727":{"type":"Text","label":"First Name","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":3,"multiline":false,"validationRules":{"required":true},"hideLabel":false},"text_322450854217988":{"type":"Text","label":"Last Name","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":4,"validationRules":{"required":true},"hideLabel":false},"email_56969655482013":{"type":"Email","label":"What is your email address?","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":5,"hideLabel":false},"phone_714906604341255":{"type":"Phone","label":"What is your phone number?","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":6,"hideLabel":false,"customQueryParamName":"phone"},"decorative_header_171555512718524":{"type":"Decorative Header","value":"We can't help you if you are already represented by an Attorney for this lawsuit. If you've made a mistake, click 'back'.","width":12,"stepId":"c6713a0fe5299542239f8a90","sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"}}},"hidden_401676091091106":{"type":"Hidden","hiddenFieldName":"utm_source","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":3},"hidden_851736750090217":{"type":"Hidden","hiddenFieldName":"utm_medium","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":4},"hidden_766171750375034":{"type":"Hidden","hiddenFieldName":"utm_campaign","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":5},"hidden_890099763029058":{"type":"Hidden","hiddenFieldName":"affid","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":6},"hidden_105407969648525":{"type":"Hidden","hiddenFieldName":"fbclid","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":7,"defaultValue":""},"decorative_header_483656864050639":{"type":"Decorative Header","value":"Were you (or a loved one) directly exposed to paraquat?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"af638305e346fdec5af8ebad","margins":{"marginBottom":0}},"buttons_57263971186489":{"type":"Buttons","validationRules":{"required":true},"label":"Direct exposure","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"Yes, directly exposed - I worked with the product","id":"192368f189795a7f9199624d"},{"text":"No","image":null,"id":"1d157d166ec02c7dc610f570"}],"stepId":"af638305e346fdec5af8ebad","sortOrder":2,"hideLabel":true},"decorative_header_178073054136423":{"type":"Decorative Header","value":"How did you or a loved one use or come into contact with pesticides like Paraquat?","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"797dc88f8c77406fba2b6429","margins":{"marginBottom":0}},"buttons_841597458617109":{"type":"Buttons","validationRules":{"required":false},"label":"Symptoms","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes, tremors","id":"f2576d407d82f4aee93b6488"},{"text":"Yes, but not tremors","id":"83b768008d6e4815d3ddc1f5"},{"text":"No symptoms","id":"1f0d7ad720751487432acce4"}],"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":2,"hideLabel":true},"buttons_599332243378731":{"type":"Buttons","validationRules":{"required":false},"label":"Occupation","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Farming crops","id":"f2576d407d82f4aee93b6488"},{"text":"Landscaping","id":"83b768008d6e4815d3ddc1f5"}],"stepId":"797dc88f8c77406fba2b6429","sortOrder":2,"hideLabel":true},"decorative_header_706329414136655":{"type":"Decorative Header","value":"How frequently did you or a loved one use or come into contact with pesticides like Paraquat?","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"88ab832fa58d45caadba1f29","margins":{"marginBottom":0}},"buttons_344114001405038":{"type":"Buttons","validationRules":{"required":false},"label":"Frequency","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"1 to 5 times per year","id":"f2576d407d82f4aee93b6488"},{"text":"6 to 20 times per year","id":"83b768008d6e4815d3ddc1f5"}],"stepId":"88ab832fa58d45caadba1f29","sortOrder":2,"hideLabel":true},"zipcode_486377508605506":{"type":"Zipcode","label":"What is your zip code?","zipcodeFieldFormat":"zipcode_usa","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":7},"decorative_header_14454864016827":{"type":"Decorative Header","value":"Were you (or a loved one) indirectly exposed to paraquat?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"Bold"},"stepId":"ba6ec8141909e66202676ea2","margins":{"marginBottom":0}},"buttons_717498385395188":{"type":"Buttons","validationRules":{"required":true},"label":"Indirect exposure","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"Yes, indirectly exposed - I live near farm land","id":"192368f189795a7f9199624d"},{"text":"No","image":null,"id":"1d157d166ec02c7dc610f570"}],"stepId":"ba6ec8141909e66202676ea2","sortOrder":3,"hideLabel":true},"decorative_paragraph_929071349063491":{"type":"Decorative Paragraph","value":"This could be the case if you've lived near farmland.","width":12,"stepId":"ba6ec8141909e66202676ea2","sortOrder":2,"fieldStyle":{"fontSize":{"value":20,"unit":"px"}}},"decorative_paragraph_857578133858201":{"type":"Decorative Paragraph","value":"welcome","width":12,"stepId":"27eb4a1b1b082ade23f4559e","sortOrder":8,"customCssClasses":"step-name"},"decorative_paragraph_209648047664319":{"type":"Decorative Paragraph","value":"exposed_to_paraquat","width":12,"stepId":"af638305e346fdec5af8ebad","sortOrder":3,"customCssClasses":"step-name"},"decorative_paragraph_180039597358573":{"type":"Decorative Paragraph","value":"exposed_to_paraquat","width":12,"stepId":"ba6ec8141909e66202676ea2","sortOrder":4,"customCssClasses":"step-name"},"decorative_paragraph_738448680689393":{"type":"Decorative Paragraph","value":"injury","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":3,"customCssClasses":"step-name"},"decorative_paragraph_573695927734910":{"type":"Decorative Paragraph","value":"parkinsons_symptoms","width":12,"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":3,"customCssClasses":"step-name"},"decorative_paragraph_91799643958029":{"type":"Decorative Paragraph","value":"occupation_exposed","width":12,"stepId":"797dc88f8c77406fba2b6429","sortOrder":3,"customCssClasses":"step-name"},"decorative_paragraph_525577905046528":{"type":"Decorative Paragraph","value":"usage_instance","width":12,"stepId":"88ab832fa58d45caadba1f29","sortOrder":3,"customCssClasses":"step-name"},"decorative_paragraph_615343648491918":{"type":"Decorative Paragraph","value":"attorney","width":12,"stepId":"fadba8819fe0505b9cb9f326","sortOrder":4,"customCssClasses":"step-name"},"decorative_paragraph_984739525574813":{"type":"Decorative Paragraph","value":"attorney_mismatch","width":12,"stepId":"c6713a0fe5299542239f8a90","sortOrder":2,"customCssClasses":"step-name"},"decorative_paragraph_44501236177660":{"type":"Decorative Paragraph","value":"personal_information","width":12,"stepId":"8738f58293daa382ea86e475","sortOrder":8,"customCssClasses":"step-name"}},"options":{"numberOfSteps":5,"dateFormat":"DD/MM/YYYY","progressBar":{"enable":true},"continueButton":{"continueText":"Next","submitText":"Receive results","backText":"Back"},"customStyles":{"width":{"unit":"px","value":580},"parentContainerMinHeight":{"value":0,"unit":"px"},"parentBackgroundImage":{"imageInitialHeight":1362,"imageInitialWidth":2066,"imageHeight":1362,"imageWidth":2066,"imageUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1597337140/uploads/qmsfk98ank3wfp1ehvyg.jpg"},"headerMarginTop":40,"parentBackgroundColor":"#ffffff","innerFormBackgroundColor":"#ffffff","innerFormBackgroundTransparency":"","primaryColor":"#0a83ca","bodyTextColor":"#343434","parentContainerBackgroundType":"color","innerFormBackgroundType":"none","buttonBorderColor":"#ff7500","buttonColorSelected":"#ffa659","buttonBorderColorSelected":"#ff7500","footerMarginBottom":70,"errorColor":"#ff4e4e","buttonColor":"#ff7500","buttonTextColor":"#ffffff","inputLabelColor":"#a3a3a3","inputTextColor":"#000000","defaultFont":"Open Sans","sq_buttonFont":"Poppins","sq_buttonFontSize":15,"showShadows":"Yes","sq_buttonTextColor":"#343434","sq_buttonColor":"#FFFFFF","sq_buttonColorSelected":"#FFFFFF","sq_buttonBorderColor":"#DADADA","sq_buttonBorderColorSelected":"primary","sq_buttonBannerColor":"#ffffff","rt_buttonFont":"Poppins","rt_buttonFontSize":15,"rt_buttonColor":"#FFFFFF","rt_buttonColorSelected":"#FFFFFF","rt_buttonTextColor":"#343434","rt_buttonBorderColor":"#DADADA","rt_buttonBorderColorSelected":"primary","inputLabelFont":"Poppins","inputFontSize":16,"continueSubmitButtonFontSize":15,"fullModeBackgroundColor":"#ffffff","canvasSetup":"full","link_buttonColor":"#34ca37","link_buttonTextColor":"#ffffff"},"localization":{"dateFormat":"MM/DD/YYYY"},"exportTransparentBackground":false,"customScript":"","customRedirectUrls":[{"url":"https://legalclaimassistant.com/paraquat-thank-you/","conditionalLogic":{"ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_109446974978914","operator":"selected_option","criteria":"192368f189795a7f9199624d"}]},{"sortOrder":2,"rules":[{"observedField":"buttons_861829943747678","operator":"selected_option","criteria":"d8a04793f71f8079aa557592"}]},{"sortOrder":3,"rules":[{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"192368f189795a7f9199624d"}]},{"sortOrder":4,"rules":[{"observedField":"buttons_841597458617109","operator":"not_selected_option","criteria":"1f0d7ad720751487432acce4"}]}]}},{"url":"https://legalclaimassistant.com/paraquat-one-more-step/","conditionalLogic":{"ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_109446974978914","operator":"selected_option","criteria":"70c0a9378e749251d6da0647"},{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"70c0a9378e749251d6da0647"},{"observedField":"buttons_57263971186489","operator":"selected_option","criteria":"1d157d166ec02c7dc610f570"},{"observedField":"buttons_841597458617109","operator":"selected_option","criteria":"1f0d7ad720751487432acce4"},{"observedField":"buttons_861829943747678","operator":"selected_option","criteria":"833967cf9a728253200929a9"}]}]}}],"logo":{"value":"https://res.cloudinary.com/dqnjggegp/image/upload/v1736173261/uploads/ekrnrakviufuxdxqwdhh.png","linkUrl":"","imageWidth":54,"imageHeight":20,"imageInitialWidth":1546,"imageInitialHeight":577},"additionalInfo":{"component":"decorativeParagraph","decorativeParagraph":{"value":"🔒 All Case Reviews are free and fully confidential"}},"footer":{"component":"decorativeParagraph","decorativeParagraph":{"value":"Attorney Advertising Disclaimer: The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. Prior results do not guarantee a similar outcome.\n\nThis website is not part of the Facebook, Inc. Additionally, this site is NOT endorsed by Facebook, Inc. in any way. Facebook is a trademark of Facebook, INC.\n\n© 2025 Legal Claim Assistant. All Rights Reserved.\n\n[Terms of Service](https://legalclaimassistant.com/terms-and-conditions/) | [Privacy Policy](https://legalclaimassistant.com/privacy-policy/) | [Contact Us](https://legalclaimassistant.com/contact/) | [Marketing Partners](https://legalclaimassistant.com/marketing-partners/)"}},"captureSystemDetails":true,"actionOnSubmit":"redirect","sendCustomRedirectQueryParams":true,"analyticsSettings":{"trustedForm":{"enabled":true},"google_analytics":{"trackingId":"G-TCY2DS6HJ9"},"custom_gtm":{"childContainerId":"GTM-KCQJVTL5","parentContainerId":"GTM-T2D8L7SQ"}},"customCss":".MuiFilledInput-input{\nmin-height: 40px;\n}\n\n.react-tel-input .form-control{\nmin-height: 80px;\n}"},"ownedByUser":"677a656476f3b5000b4f2ab7","personalisation":{"form_related_to":"(None - start with a blank slate)"},"created":"2025-01-13T14:04:31.447Z","__v":0,"lastEdited":"2025-04-23T14:07:04.445Z","screenshotUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1745406934/growform-production/form-screenshots/67851d6fb60c39000be0015d.png","leadsCount":161,"isActive":true},"accountIsActive":true,"accountIsFreeTrial":false}}; // ---- Utils ---- function safeJSONStringify(obj) { return JSON.stringify(obj) .replace(/<\/(script|style)/gi, '<\\/$1') .replace(//g, '--\\>') .replace(/\u2028/g, '\\u2028') .replace(/\u2029/g, '\\u2029'); } function preloadScript(href) { try { if (!href) return; if (document.querySelector('link[rel="preload"][href="' + href + '"]')) return; var l = document.createElement("link"); l.rel = "preload"; l.as = "script"; l.href = href; l.crossOrigin = ""; // allow cache reuse in iframe document.head.appendChild(l); } catch (_) {} } function parseQuery() { var out = {}; try { if (!window.location.search) return out; var usp = new URLSearchParams(window.location.search); usp.forEach(function (v, k) { out[k] = v; }); } catch (_) {} return out; } function buildIframeHTML(opts) { var html = '\n' + '\n' + '\n' + ' \n' + ' \n' + ' \n' + '\n' + '\n' + ' \n' + '
\n' + '