Get Biomet Class Action Intake Form - Wagners - Wagners

The Biomet class action intake form serves as a crucial document for individuals who have been affected by Biomet hip implants. This guide will provide you with clear, step-by-step instructions on how to accurately complete the form to aid your claim.

Follow the steps to fill out the Biomet class action intake form online.

1. Click ‘Get Form’ button to obtain the form and open it in your desired editor.
2. Fill in the date on the form, ensuring accuracy in all personal details.
3. Provide the claimant's name, including first, middle, and last names. If the claimant is deceased, please check the appropriate box and provide the date of death.
4. Enter the claimant's contact address, along with home phone, cell phone, facsimile number, and email.
5. Complete the personal information section by filling in the claimant's date of birth, place of birth, social insurance number, health card number, occupation, and employer. If the claimant is retired, indicate 'Yes' or 'No'.
6. Specify the marital status by selecting from the options listed: single, married, common law, divorced, widowed, or separated. If applicable, provide divorce, widowed, or separated dates.
7. If applicable, enter the spouse’s information, including their name and date of birth.
8. If the claimant is deceased, complete the section for children, including their names and dates of birth.
9. Indicate the type of hip implant used and the corresponding dates of surgery. Ensure to provide the name of the surgeon and the hospital where the surgery was performed.
10. Answer whether you have a copy of your medical records and if you still have the implant. If removed, list necessary details such as the date, surgeon, hospital, and reasons for removal.
11. Check any medical issues experienced due to the hip implant and provide detailed descriptions of how it has affected your lifestyle, relationships, and financial situations.
12. List the family doctors and medical specialists who have treated the claimant, including their contact details.
13. Provide information regarding any other physicians or hospitals associated with the claimant's treatment.
14. Complete the pharmacy information by listing pharmacies that hold prescription records related to the claimant's treatment.
15. Finally, describe any medical problems the claimant had prior to the hip implant.
16. Review all entries for correctness. Save changes, and choose to download, print, or share the completed form as needed.

Complete your Biomet class action intake form online to ensure your claim is processed effectively.