What kind of wound do you have? *

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Foot / Ankle Wound
Calf / Lower Leg Wound
Thigh / Upper Leg Wound
Butt / Low Back Wound
Arm / Chest Wound
Head / Face Wound
Other
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How long ago did this happen? *

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Within a Week
Within a Month
Over a Month
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Do you have a Medicare policy? *

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Traditional Medicare B
Medicare Advantage
Medicare HMO or PPO
Commercial / Private
I'm Not Sure
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