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Please provide us with your city
Please provide your zip code
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Age (at Implant)
Please provide your Age at the Total Artificial Heart Implant
Please provide the Hospital that implanted your Total Artificial Heart
What Month & Year did you receive the Total Artificial Heart? (if you don’t know for sure, please provide your best guess)
Please provide what Month & Year you received the Total Artificial Heart? (if you don’t know for sure, please provide your best guess)
If applicable, what Month & Year did you receive your heart transplant? (please provide your best guess)
When were you first diagnosed with heart problems?
Please provide when you were first diagnosed with heart problems
Describe how were you first diagnosed with heart problems:
Please describe how were you first diagnosed with heart problems
Describe the symptoms and events leading up to implant of the Total Artificial Heart:
Please describe the symptoms and events leading up to implant of the Total Artificial Heart
Describe your experience while on the Total Artificial Heart:
Please describe your experience while on the Total Artificial Heart
Describe your life post-transplant:
What would you tell others about the Total Artificial Heart?
Please tell us what you would tell others about the Total Artificial Heart
Photos make a big difference when telling your story. If you would like to share your personal photos with SynCardia, please attach them here. Great examples include photos of you and your family, significant other, friends, etc. doing everyday activities while on the Total Artificial Heart, such as exercising, celebrating birthdays or anniversaries, going for walks, etc. Other great examples include you doing activities you enjoy post-transplant.
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