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My amputation is:
( Check all that apply )
Mastectomy:Single Mastectomy     
 Double Mastectomy I would like information on:
( Choose as many as you like )
Upper extremity:Shoulder level Mastectomy 
 Above elbow Breast forms
 Through elbow  Swim wear
 Below elbow Myoelectric 
Utah arm
 Wrist level I-Limb
 Partial hand  B-bionic
 Fingers  Otto Bock
Lower extremity:Hip level Computerized 
C-Leg by Otto Bock
 Above the knee Genium by Otto Bock
 Through the knee  X3 by Otto Bock
 Below the knee  Rheo by Ossur
 Ankle level  Power knee by Ossur
 Partial foot  Plie' by Freedom
 Toes Other:Vacuum/suction sockets
Other:Ear  Custom graphic finishes
 Facial  Cosmetic restorations
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