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If you are interested in the osseointegrated treatment option and would like to know if you (or another person you know) are a suitable candidate, we ask you to fill out the patient enquiry form and send it to us:
It provides us with important information so we can come up with a first evaluation of your situation and we will get back to you soon.

Generated with MOOJ Proforms Version 1.3
* Required information.
Family Name *
GivenName
Address/Street/Number
Postcode
City *
Date of birth *
Your E-Mail *
Your Phone Number
Message *
How did you find out about Osseointegration?
Date of Amputation: *
Cause of Amputation: *
Affected limb/ side: *
Level of Amputation(i.e. transfemoral/ AKA/ transtibal etc.): joints, if applicable: *
Height: *
Weight: *
Marital Status and Children:
Current type of prosthesis and artificial joints, if applicable: *
Current Employment/ Education: *
Other diseases / injuries: ungen: *
Current medication? *
Do you smoke and if so, how much? *
Do you suffer from phantom pain? *
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