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Essure Claims Evaluation Form
Essure Claims Evaluation
If you or a loved one had the Essure implant and suffered adverse side effects, you may be entitled to a cash award and financial compensation for your damages. Don’t be a silent victim. Complete this brief evaluation today and see if you qualify!
Step 1 of 6
*Did you or a loved one have the Essure birth control device implanted for permanent birth control?
*What Date did you have the Essure birth control device implanted?
*What complications have you experienced? Check all that apply.
Pain in the Pelvis
Pain in the back
Pain During Intercourse
Taste of metal
Removal of Device
*Would you like to get the device removed?
Please provide additional comments to help evaluate your case.
* Based on your responses, you may qualify for compensation!
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