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FREE CASE EVALUATION
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Patient was in a: (Check all that apply)
Hospital
Nursing Home
Rehab
Other
Location of sore(s):
Buttocks
Back/Sacrum
Hip
Other
Stage of sore(s):
Stage 1-2
Stage 3
Stage 4
Unsure
Please add any additional details:
Your Name
First Name
Last Name
Your Email
Phone Number
-
Area Code
Phone Number
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