Harborview Amputee Support Group
Mailing list
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Name:
Email:
Comment:
Email Address
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First Name
Last Name
Are you a person living limb loss or difference?
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Person living with Limb loss
Person living with limb difference
Family
non-professional caregiver
Healthcare Professional
Industry Choice
Other
Limb loss or difference site?
Left
Right
Bilateral
Trimemberal
Quadrimenbral
Other
Amputation Type
Below knee
Above knee
Below elbow
Above elbow
Lower Limb Unspecified
Upper Limb Unspecified
Forequarter
Shoulder disarticulation
Elbow disarticulation
Wrist disarticulation
Finger(s)
Partial Hand
Hand
Hemicorporectomy
Hemipelvectomy
Knee Disarticulation
Hip Disarticulation
Rotation plasty
Toe(s)
Partial Foot
Foot
Symes
Other
Cause of amputation?
Trauma
Cancer
Congenital
Vascular
Diabetes
Infection
Sepsis
Disease Related
Other
Unknown
