
| If you or a loved
one has suffered injury or fear potential complications as a
result of procedures using the Guidant Ancure contact us to find
out about your legal options. Our attorneys have recovered millions
of dollars for people injured by medical devices. Please read and agree to our terms and conditions. Your information will be kept private and confidential and used for the sole purpose of helping you learn your rights. |
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Title: |
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First Name: |
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M. I. |
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Last Name: |
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Address: |
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City: |
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State: |
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Zip Code: |
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Phone Number (day): |
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Phone Number (eve): |
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Email Address |
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Title: |
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First Name: |
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M. I. |
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Last Name: |
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What is the Injured's relationship to you?: |
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Injured's Date of
Birth? |
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Have you been diagnosed with an Abdominal Aortic Aneurysm? |
Yes No |
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Have you had surgery to repair the aneurysm? |
Yes No |
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What was the date of surgery? |
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Was the Guidant Ancure Device used during surgery? |
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Was the device put in through the groin or abdomen? |
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Where was the Stent placed? |
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What complications have you been experienced since the surgery? |
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| Do you currently have an attorney assisting you with this matter? | |
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| I understand that submitting this form does not create an attorney client relationship: Agree | |