Gingras, Cates & Luebke Lawyers | DePuy Hip Implant Inquiry

Please submit your inquiry via our secure online form. Your privacy is important, and your personal information will not ever be shared. Read our privacy policy.

NOTE: A minimum of 1 valid phone number is required. ALL fields noted with an asterisk [*] are required.

Name *
Address *
City *
State *
ZIP *
Cell Phone (example 123-456-7890)
Home Phone (example 123-456-7890)
Work Phone (example 123-456-7890)
Email Address *
Date of Birth * (MM/DD/YYYY)
Have you had hip replacement surgery? *
Date of right hip surgery (MM/DD/YYYY)
Date of left hip surgery (MM/DD/YYYY)
Do you know the manufacturer of your hip replacement device? *
How did you become aware of manufacturer information? (e.g., doctor, medical records, implant page, etc.)
Did you experience any problems relating to your hip prosthesis? *
Did you receive a letter from your doctor or DePuy notifying you of the recall? *
If yes, when? (MM/DD/YYYY)
Did the letter advise you to get any tests such as X-Rays, blood tests, MRI's, etc.? *
Has a doctor told you that your hip implant may need replacing? *
Do you have a hip revision or replacement surgery scheduled? *
If yes, when? (MM/DD/YYYY)
What is the best time of day to reach you? *
What is the best phone number to reach you? *

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Gingras, Cates & Luebke Lawyers | DePuy Hip Implant Inquiry

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