Gilead Document Survey – Hilliard Law

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Last Name

Do you have any documents in your possession related to your kidney or bone injuries or HIV treatment?

Yes
No

Please select from the list any documents in your possession related to your kidney or bone injuries or HIV treatment: (Please select all that apply)

Do you have any Pharmacy records related to your HIV medications?

Yes
No

Please select from the list any Pharmacy records in your possession related to your HIV medication: (Please select all that apply)

Do you have any documents in your possession related to your HIV Medication?

Yes
No

Please select from the list any documents in your possession related to your HIV medication: (Please select all that apply)

Do you have any documents in your possession related to Workers’ Compensation, Social Security, Disability Proceedings?

Yes
No

Please select from the list any documents in your possession related to your Workers’ Compensation, Social Security, Disability Proceedings : (Please select all that apply)

Do you have any documents in your possession related to lost wages?

Yes
No

Please select from the list any documents in your possession related to your lost wages: (Please select all that apply)

Do you have any documents in your possession related to Gilead Sciences, Inc.?

Yes
No

Please select from the list any documents in your possession related to Gilead Sciences, Inc.: (Please select all that apply)

Do you have any personal documents in your possession related to your HIV medications, injuries, damages or the lawsuit?

Yes
No

Please select from the list any personal documents related to your HIV medications, injuries, damages or the lawsuit: (Please select all that apply)

Please describe any other documents you have in your possession relating to your HIV medications, HIV treatment, injuries, or the lawsuit against Gilead:

Name

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