Knee Replacement
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Have You Had Knee Replacement Surgery?

Thank you for agreeing to fill out this brief survey.

As someone who may have benefited from knee replacement, we want to learn more about your experience. Please answer the questions below as appropriate.

DePuy will not sell or share your personal information with any third parties or outside mailing lists except as required by law or stated in our Privacy Policy.

To be removed from our mailing list, please email us at askdepuy@dpyus.jnj.com.  


* Indicates fields that are required
 
  When was your knee replacement?  
    1-5 months ago   6 months ago or longer    
 
  Did you receive a DePuy knee replacement?  
    Yes   No   I Don't Know    
 
  Would you be interested in sharing your knee replacement surgery experience with others:  
    Yes   No    
 
  How has knee replacement affected your life? What are you able to do now that you
couldn't do before?		  
     
 
  First Name:  
     
 
  Last Name:  
     
 
  Address:  
     
 
  City:  
     
 
  State:  
     
 
  Zip:  
     
 
  Phone:  
     
 
  Year of Birth:  
     
 
  Surgeon's Name:  
     
 
  Gender:  
    Male   Female    
 
  *I understand that DePuy may potentially contact me by phone or email to ask me
about my experience with knee replacement surgery.		  
    Accept    
 
       
 

 

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