Surgeons or other health-care providers may need to provide patient information to LifeNet Health for the purpose of providing allograft implants that ideally match patient anatomy. This patient disclosure form enables that information to be transmitted between LifeNet Health offices. For questions related to the disclosure form, contact eu_service@lifenethealth.eu.
- Download a fillable PDF of the Patient Disclosure Form in English.
- Download a fillable PDF of the Patient Disclosure Form in German.
- Download a fillable PDF of the Patient Disclosure Form in Spanish.
- Download a fillable PDF of the Patient Disclosure Form in French.
- Download a fillable PDF of the Patient Disclosure Form in Italian.
- Download a fillable PDF of the Patient Disclosure Form in Dutch.
- Download a fillable PDF of the Patient Disclosure Form in Norwegian.
- Download a fillable PDF of the Patient Disclosure Form in Swedish.