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Implant Device Questionnaire
Please complete this short questionnaire to see if you qualify
Step 1 of 6
Is this claim for a hip or knee implant device?
Which side of the body is the device implanted?
Do you have your medical records or implant ID card?
Please select your hip manufacturer:
Smith & Nephew
If you know your hip model, please list here:
When was the device implanted?
What's the name of the hospital where the surgery occurred?
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
After surgery, when did you first experience problems?
Please select the problems you experienced:
Reduced range of motion
Loss of mobility
Loosening or instability
Have you had a revision surgery on the implant?
If you've had any revisions, list years here:
Please provide additional comments to help evaluate your case.
* Based on your responses, you may qualify for compensation!
Full Postal Address
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