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AMO Lens Solution Canada (may cause blindness)
Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersAndSettlements.com.
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Defendant:
(who caused the harm?)
AMO Lens Solution Canada (may cause blindness)
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Describe your complaint:
(briefly describe the damages you have suffered)
Name of product used:
Do you still have the product or proof of purchase?
Yes
No
Length of time product was used:
Frequency of use (daily, weekly, etc.)
Description of infection or illness:
Description of required treatment :
Prognosis (if known)
Was surgery required?
Yes
No
If so, what surgery and when?
Name, address, telephone number of Ophthalmologist:
Name, address, telephone number of family physician:
Summary of expenses for treatment, medications, etc. (please list each item and the associated expense)
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