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Register your interest here!
Contact Information
Name
First Name
Last Name
Email
Verify Email
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
How do you describe yourself?
*
Please select one of the lines below that best describes you.
select one
Mesh Injured - male
Mesh Injured - female
Carer or Friend of mesh injured
Had mesh used in surgery, am unwell, seeking knowledge about mesh injury
My surgeon has recommended mesh in my repair
Seeking info about "non mesh" repair
Health Professional
Mesh lobbyist outside of Australia
Other interested party
Interest in Mesh Injured Australia
Please indicate how you would like to interract with Mesh Injured Australia Inc
Please keep me updated with a newsletter or email with mesh injured associated information
I would like to become a member of Mesh Injured Australia Inc.
I would like to provide information to assist with statistics and lobbying on behalf of Mesh Injured Australia, and understand that my identifying information WILL NOT be provided to a third party at any time.
I am interested in volunteering with MIA (MIA is working on different volunteer activities that may become available)
I am interested in fundraising to assist MIA to support mesh injured.
All the above!
Detail of your mesh implant
Only fill in this section if it is applicable to you, and only if you are happy to provide the detail. The detail will only be used to identify trends and statistics. Your information will remain private within our system.
Do you have your Operation Record from when mesh was implanted?
Not applicable to me
Yes and it contains the sticker/label of the implant
Yes but it doesn't contain the sticker/label
No, the record has been destroyed
No, I am still in process of trying to obtain them
Have you lodged an "adverse event" report with the TGA?
Yes
No, I haven't got around to it
No, could someone please contact me to help?
No, I don't want to
When were you implanted with mesh?
If applicable
prior to 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Name of the hospital where you were implanted?
Name of hospital only (city/town and state are separate answers)
City/Town of the implanting hospital
Please state the city or town of the hospital where you were implanted
State where the hospital is located?
select one
NSW
VIC
QLD
SA
TAS
WA
ACT
NT
Name of implanting surgeon (only if comfortable to provide)
Full name or surname is fine
Qualification of implanting surgeon
Please indicate the qualification of the implanting surgeon (if known)
select one
Urogynaecologist
Urologist
Gynaecologist
Obstetrician
Rectal Surgeon
General Surgeon
Other
Name of mesh
ie. was it a Gynaecare TVT Retropubic system (please provide what you can)
What type of mesh implant was it?
Please pick the type that best describes the type of repair that caused your mesh implant
Stress Urinary Incontinence
Prolapse of bowel
Prolapse of bladder
Vaginal support
Hernia - umbilical
Hernia - Inguinal
Hernia - Other
Other
Please take a photo of your Operation Record to validate your mesh injury here.
Mesh injury validation will assist with any application for access to private forums within our website.