* Indicates required information.
Tell us how life has changed since you or a loved one received a HeartMate II® *(Was there an improved quality of life, more energy, etc.) †
Provide your contact information so we can follow up if needed.(If your story is featured, only your first name will be displayed on our website.)
Tell us a bit about yourself and the things you enjoy doing.
Tell us about your diagnosis and treatment.
Do you have photos or videos to help tell your story? Before and after?
I hereby agree to provide the information, which appears above regarding my experience voluntarily and without compensation, to Thoratec Corporation ("Experience Statement"). Thoratec Corporation will have the right to attribute my Experience Statement (or statements in different words which have substantially the same meaning) and photos of me, which are an expression of my personal experience and belief. I hereby grant Thoratec Corporation the right and license to use my name, comments, clinical and demographic information, such as data on my heart failure condition, age and hometown, in Thoratec's materials for internal and external audiences. I understand that these materials include but are not limited to advertisements, brochures, news releases, magazines, newspapers, newsletters, videos, multimedia and Web sites. I hereby further release Thoratec Corporation from any and all claims, damages, liabilities, costs and expenses which may result from the aforementioned information.
† Please consult the Instructions for Use for indication for use, contraindications, warnings, and adverse events. Individual experiences, symptoms, situations, and circumstances may vary. Please consult your physician or qualified health provider regarding your condition and appropriate medical treatment.