INFORMATION REGARDING OTHER TYPES OF BREAST IMPLANTS Sample Clauses

INFORMATION REGARDING OTHER TYPES OF BREAST IMPLANTS a. Please provide the date and place of implantation of silicone breast implant(s) other than Dow Corning Breast Implant(s) and (if known) the name, model and/or manufacturer of your implant(s). Date City, Province Name/Model/Manufacturer of Implant Date City, Province Name/Model/Manufacturer of Implant
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