Prosthetic Urology Implant Identification Card (ID cards) 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. If you received an ID card at your procedure, no further action is needed, and you do not need to request another ID card. To request your initial ID card if you didn't receive one at your procedure, or if you are in need of a replacement ID card, 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 AMS Ambicor™ Penile Implant Spectra™ Penile Implant Tactra™ Penile Implant AdVance™ or AdVance™ XP Male Sling AMS 800™ Artificial Urinary Sphincter

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Prosthetic Urology Implant Identification Card (ID cards) and User Guide Request Form