Get Canada Murphy Battista Hernia Mesh Class Action Client Information Questionnaire 2018-2025

Filling out the Canada Murphy Battista Hernia Mesh Class Action Client Information Questionnaire online is an important step for individuals seeking to participate in the class action. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the questionnaire seamlessly.

1. Click ‘Get Form’ button to obtain the questionnaire and open it in your preferred document editor.
2. Begin by filling out the 'Client Identification' section. Enter your first, middle, and last name, as well as any other names or aliases you may have used. Input your current address, home phone, cell phone, email, date of birth, health care number, and marital status. If you have a spouse, include their name as well.
3. Proceed to the 'Emergency Contact' section. Provide the first name of your emergency contact, their current address, home phone, cell phone, email, and the relationship you have with them.
4. In the 'Hernia Mesh Information' section, indicate the approximate date your original mesh was implanted and the city and hospital where this occurred. Include the name and address of the surgeon who performed the implantation.
5. Continue by detailing the brand name or type of mesh used if known. If you have received more than one hernia repair, answer 'Yes' and provide the approximate dates, the cities and hospitals where each repair occurred, and the names and addresses of the surgeons for each repair.
6. Answer questions regarding your mesh removal and replacement. If applicable, provide the surgeon's name and address as well as the hospital or facility where these procedures took place.
7. List any injuries or symptoms you have experienced after the mesh implantation. Check all relevant selections and note the approximate date when these symptoms first arose. Include the name and address of the physician(s) who diagnosed your condition.
8. Fill in the 'Additional Questions' section about your future treatment plans and whether you have access to your hospital/surgical records. Name your current, previous, and family doctors relevant to the mesh procedure.
9. Complete the 'Employment Information' section by indicating your employment status and providing details if you are currently employed, including your occupation, employer, and date of hire. Note any work missed due to mesh issues and provide income details as needed.
10. Conclude by entering any additional comments or significant health problems experienced due to the hernia mesh, including dates of onset.
11. Before submitting, review all entries for accuracy. Once satisfied, save your changes, and you may download, print, or share the completed questionnaire as needed.

Take action today by completing the Canada Murphy Battista Hernia Mesh Class Action Client Information Questionnaire online.