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First Name
*
Last Name (at time of surgery)
*
Last Name (current)
Email Address
*
Hometown
*
Tube of Email
Date of Reversal
*
Doctor Who Performed Surgery
*
Dr. William Greene Jr.
Dr. Wendell A. Turner
Age at Time of Reversal
Type of Tubal Ligation
*
Tubal Clips (clamps)
Tubal Rings (bands)
Resection (tied or cut)
Coagulation (burned)
Fimbriectomy
Essure
Adiana
Other/unknown
Finished Tube Length
Baby's Photo
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