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Home > JUUL Questionnaire

JUUL Questionnaire

Date

MM slash DD slash YYYY

Name(Required)

First Last

Age(Required)

Are you a current or former JUUL user?(Required)

Yes

No

User Type(Required)

Former

Current

Are you a parent, education professional, or other person affected by JUUL?(Required)

Yes

No

Are you a(Required)

Parent

Education Professional

Other person affected by JUUL

Email Address(Required)

Phone Number

Best time to contact you

Are you involved in any lawsuit against a tobacco or e-cigarette manufacturer?(Required)

Yes

No

Are you represented by an attorney?(Required)

Yes

No

Attorney's Name(Required)

First Last

Attorney's firm name(Required)

Attorney's Phone Number(Required)

Attorney's Email Address(Required)

Your Experience

Please briefly tell us how JUUL has affected you (examples: health effects, social effects, addiction struggles, quit attempts, etc.):

Tobacco Enforcement Section
15th Floor, Strawberry Square
Harrisburg, PA 17120

1-717-783-1794

eciglawsuit@attorneygeneral.gov

Click here for JUUL Lawsuit resources including the Parental/Guardian Consent Form.

Divisions: Criminal Law Division; Public Protection Division; Civil Law Division; Office of Public Engagement

Contact

Pennsylvania Office of Attorney General Strawberry Square
Harrisburg, PA 17120
717-787-3391

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