Office Locations

Tallahassee
(Map and Directions )
3375-A Capital Circle N.E.
Tallahassee, FL 32308
Toll Free Phone: (877) ALL WE DO
Local Phone: (850) 553-HELP
or (850) 422-7773
Fax: (850) 422-3449

Key West
(Map and Directions )
608 Whitehead Street
Key West, FL 33040
Toll Free Phone: (877) ALL WE DO
Local Phone: (305) 294-4585
Fax: (305) 294-7822

Thomasville
(Map and Directions )
214 West Jackson Street
Thomasville, GA 31792
Toll Free Phone: (877) ALL WE DO
Local Phone: (229) 226-HELP
(229) 226-4357

Surgical Mesh Questionnaire

CLICK HERE if you would prefer to print and mail or fax the Surgical Mesh Questionnaire to our office for review.

Contact Information
Name:
Relationship to injured person:
Home Phone:
Work Phone:
Mobile Phone:
Mailing Address:
City, State Zip:
E-mail:
How did you hear about us?

When was the procedure performed? Date:

Where did you receive your surgical mesh?

      Hospital/Facility:

      City:

      State:

Have you had any additional surgery? Yes No

What symptoms or complications have you suffered?

Abdominal Pain
Inflammation
Vaginal Discharge
Infection
Bleeding
Erosion/protrusion of the mesh
Painful Intercourse
Urinary Incontinence
Vaginal Prolapse
Other

How has this injury affected your life?

NOTE: In sending us email or submitting a form, you are not establishing an attorney-client relationship. Do not send confidential case-related information using this form.

Office Locations

Surgical Mesh Questionnaire

Contact Information