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• Did you or your loved one have a Spinal Cord Stimulator implanted?*
  Select OneYesNo
• Why was the SCS implanted?*
  Select OnePain ManagementSpinal Cord InjuryBladder IssuesSleep ApneaOther
• What injury did you experience from the SCS implant?*
  Select OneBurning caused by the deviceElectric shock from the deviceLead wire fracture/migrationUrinary incontinence or retentionGastroparesisDysphagiaUncontrollable diarrheaDizziness/faintingIneffective or worsening of painCardiac arrhythmiaNo longer able to receive an MRIOther injury not listedNone of the above

• In which state was the SCS implanted?*
  Select OneALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY
• In what year was the SCS implanted?*
  Select OneBefore 20172018 or later

• Which brand of SCS device was implanted?*
  Select OneAbbottBoston ScienceMedtronicNevroSt. JudeOther/Unknown
• Are you currently working with an attorney?*
  Select OneYesNo
• Name*
• Phone*
• What's your email address?*
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