::ADSA::

CONTACT ADSA

Asbestos Diseases Society of Australia Inc

Street Address
219 Main Street
Osborne Park WA 6017

Postal Address
PO BOX 1394
Osborne Park WA 6916

Telephone
1800 646 690 (National Toll Free)
(08) 9344 4077 (Perth Callers)
+61 8 9344 4077 (International Callers)

Fax
(08) 9345 0422
+61 8 9345 0422 (International Faxes)

General Contact Form

First Name:
Last Name:
Street Address:
Suburb:
State:	Post Code:
Country:
Telephone:
Fax:
E-mail:
Date of Birth:
Who are you enquiring about?
Have you been diagnosed with: (Check the box that applies) Mesothelioma Lung Cancer Asbestosis None
When were you diagnosed (Date):
Are you currently represented by a legal practicioner in an Asbestos Claim? Yes No
Would you like someone from our office to: Send you asbestos disease information Follow up with a call Schedule a time to meet with you
Please include any additional comments you might have. Be sure to include any locations where you feel you might have been exposed to asbestos. Please tell us more about yourself including: Your age Your current line of work The effects of your condition