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Downwinders® Claims

Downwinders®
Downwinders Claim Forms
Downwinders Maps and Covered Cancers

Bile Duct Cancer | Bladder Cancer | Brain Cancer | Breast Cancer | Colon Cancer | Esophagus Cancer | Gall Bladder Cancer | Leukemia | Liver Cancer | Lung Cancer | Multiple Myeloma | Nasal Pharynx Cancer | Lymphoma | Ovarian Cancer | Pancreas Cancer | Rectal Cancer | Salivary Gland Cancer | Small Intestine Cancer | Stomach Cancer | Thyroid Cancer

Downwinders®

Toll Free 1 (855) 631-7197

Get Started on Your Radiation Exposure Compensation Claim

Downwinders Radiation Exposure Compensation Form

Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone*
Relationship to the person diagnosed with Cancer
- Self
- Spouse
- Child
- Grandchild
- Parent
Type of Cancer
- Bile Duct
- Bladder
- Brain
- Breast (male or female)
- Colon
- Esophagus
- Gallbladder
- Leukemia (other than CLL or Chronic Lymphocytic Leukemia)
- Liver (if no evidence of cirrhosis or hepatitis B)
- Lung
- Lymphomas (except for Hodgkin’s disease)
- Multiple Myeloma
- Nasal Pharynx
- Ovarian
- Pancreas
- Rectal
- Salivary Gland
- Small Intestine
- Stomach
- Thyroid
Which of the following States/Counties between 1951 and 1962 did the person diagnosed with cancer reside.
- Arizona
- Apache
- Coconino
- Gila
- Navajo
- Yavapai
- Nevada
- Eureka
- Lander
- Lincoln
- Nye
- White Pine or the North East portion of Clark
- Utah
- Beaver
- Garfield
- Iron
- Kane
- Millard
- Piute
- San Juan
- Sevier
- Washington
- Wayne
Please submit form or print and mail with medical diagnoses to:
Downwinders
1300 South Milton RD., Suite 214 Flagstaff, AZ 86001
For Claims assistance please call (855) 631-7197
Email
This field is for validation purposes and should be left unchanged.

Downwinders Claims

Downwinders® Claims

Toll Free: 1 (855) 631-7197

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Contact Us

Downwinders Radiation Exposure Compensation Form

Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone*
Relationship to the person diagnosed with Cancer
- Self
- Spouse
- Child
- Grandchild
- Parent
Type of Cancer
- Bile Duct
- Bladder
- Brain
- Breast (male or female)
- Colon
- Esophagus
- Gallbladder
- Leukemia (other than CLL or Chronic Lymphocytic Leukemia)
- Liver (if no evidence of cirrhosis or hepatitis B)
- Lung
- Lymphomas (except for Hodgkin’s disease)
- Multiple Myeloma
- Nasal Pharynx
- Ovarian
- Pancreas
- Rectal
- Salivary Gland
- Small Intestine
- Stomach
- Thyroid
Which of the following States/Counties between 1951 and 1962 did the person diagnosed with cancer reside.
- Arizona
- Apache
- Coconino
- Gila
- Navajo
- Yavapai
- Nevada
- Eureka
- Lander
- Lincoln
- Nye
- White Pine or the North East portion of Clark
- Utah
- Beaver
- Garfield
- Iron
- Kane
- Millard
- Piute
- San Juan
- Sevier
- Washington
- Wayne
Please submit form or print and mail with medical diagnoses to:
Downwinders
1300 South Milton RD., Suite 214 Flagstaff, AZ 86001
For Claims assistance please call (855) 631-7197
Phone
This field is for validation purposes and should be left unchanged.

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