IVC: Client Client Criteria Questionnaire

Name *

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Email *

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Address *

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Do you currently have, or have you had, an IVC filter? Do you know who manufactured the filter (i.e., Cook, Bard, Johnson & Johnson, Cordis, Boston Scientific, etc.)? *

When was the IVC filter put in? *

Have you had any medical problems or hospitalizations that may have been related to the filter? If so, what were the problems? *

Have you had the filter removed? If so, when was it removed and were there any problems with the removal? *

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Connecticut Personal Injury Lawyers

IVC: Client Client Criteria Questionnaire