Prosthetic Urology Implant Identification Card and User Guide Request Form

Congratulations on your decision to receive a Boston Scientific Men’s Health implant

Identification cards are provided as part of your post-procedure support. To request your wallet ID card and information, please complete the fields below confirming your implant details.

* Denotes required field

First Name

Last Name

Street Address

City

State

Zip

Phone

Your Implanting Urologist:

Procedure Date:

Device Implanted: AMS 700™ Penile Implant (ID card and user guide will be sent) AMS Ambicor™ Penile Implant (ID card and user guide will be sent) Spectra™ Penile Implant (ID card and user guide will be sent) Tactra™ Penile Implant (ID card will be sent) AdVance™ or AdVance™ XP Male Sling (Post-procedure guide will be sent) AMS 800™ Artificial Urinary Sphincter (ID Card and user guide will be sent)

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Prosthetic Urology Implant Identification Card and User Guide Request Form