We know and understand that this is a sensitive issue and coming forward is difficult in many ways. If you have questions or want to discuss a potential case, you may complete this form or call 1.888.425.2020. Name Telephone Number Email Address What state do you live in Have you or your child been diagnosed with an eating disorder or attempted/committed suicide that you believe was influenced by social media? Yes No Did your child begin using social media before age 10? Yes No Did Instagram contribute to the diagnosis or injury? Yes No Age when social media use started Age at time of diagnosis or injury Current age Which other technology contributed to the diagnosis or injury? (Check all that apply) Facebook WhatsApp Other… Enter other… Tell us about your potential case (500 character limit) By submitting this form, I agree that Motley Rice LLC may collect my information and use it pursuant to its privacy policy. Yes No If you do not agree with our website privacy policy please call 1.800.768.4026 to discuss your potential case. Leave this field blank