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How do I fill this out?
To fill out this form, begin by ensuring you have accurate measurements. Select the desired features that best fit your needs. Finally, submit your form and await your tailored breast form.
How to fill out the Amoena Custom Breast Forms Overview and Instructions?
1
Review the fitting requirements thoroughly.
2
Take precise measurements of your chest.
3
Choose your preferred options for the custom form.
4
Submit your completed form to Amoena.
5
Await the confirmation and fitting appointment.
Who needs the Amoena Custom Breast Forms Overview and Instructions?
1
Women post-mastectomy seeking a custom fit for comfort.
2
Individuals who have experienced breast-conserving surgery.
3
Patients undergoing reconstruction looking for personalized forms.
4
Women needing prosthetics due to complications post-surgery.
5
Anyone requiring breast form adjustments after implant removal.
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What are the instructions for submitting this form?
To submit this form, you can send a digital copy via email to our support team or fax it to our dedicated line. For physical submissions, please mail it to the Amoena USA Corporation in Kennesaw, GA. We advise keeping a copy of your submission for your records.
What are the important dates for this form in 2024 and 2025?
Important dates for the form include submission deadlines for insurance approval and fitting appointments. Ensure to check specifics for 2024 and 2025, as these may vary. Staying informed will help streamline your process.
What is the purpose of this form?
The purpose of this form is to facilitate the creation of custom breast forms tailored specifically to your unique requirements. It allows you to provide all necessary information for a fitting that ensures optimal comfort and confidence. This form serves as a critical step in enhancing the quality of life for women after breast surgery.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Basic details such as name, contact, and medical history.
- 2. Surgery Details: Information about the type of surgery performed.
- 3. Preferred Features: Selections regarding size, weight, and design of the breast form.
- 4. Insurance Information: Details regarding your insurance provider for pre-approval.
What happens if I fail to submit this form?
Failing to submit this form may delay the fitting process for your breast form. It could also lead to additional complications in insurance approvals. Ensure that all required fields are completed to prevent any interruptions in service.
- Delayed Custom Fit: Without timely submission, your fitting process will be postponed.
- Insurance Issues: Incomplete forms may result in delays in insurance pre-approval.
- Incorrect Measurements: Failure to provide accurate information can lead to issues with the fit.
How do I know when to use this form?
- 1. Post-Mastectomy: Women who have undergone mastectomy procedures.
- 2. Breast Reconstruction: Individuals requiring custom forms following reconstruction surgery.
- 3. Prosthetic Needs: Patients needing breast prosthetics after surgery.
Frequently Asked Question
What types of customizations are available for the breast forms?
You can choose from various shapes, sizes, and weights tailored to your preferences.
How long does the custom fitting process take?
Typically, it takes about six weeks from scan to final fitting.
Can insurance cover the costs of a custom breast form?
Yes, we handle the insurance pre-approval process for you.
Is there a consultation fee for the fitting?
Consultations are free and designed to understand your needs.
How can I schedule a consultation?
You can schedule a consultation easily via our website or by calling our office.
What do I need to bring to my fitting appointment?
Bring any prescribed documents and previous medical records relevant to your surgery.
Will I get to try on different forms during the fitting?
Yes, we offer a selection of forms to help you choose the right fit.
What if my form doesn't fit after the fitting?
We will make adjustments as needed to ensure your complete satisfaction.
Can I refer friends to Amoena for custom breast forms?
Yes, referrals are welcome and appreciated.
What happens if I forget my appointment?
Please notify us as soon as possible to reschedule your fitting.
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