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intake test forms
Do you have an Essure birth control implant?
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Do you have an Essure birth control implant?
Select One
Yes
No
I'm not sure.
Are you experiencing problems related to your Essure implant?
Select One
Yes
No
I'm not sure.
Are you already represented by an attorney?
Select One
Yes
No
I'm not sure.
I understand that by submitting this form I am not entering into an attorney-client relationship.
*indicates required field