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Allergan implant enquiry form

All fields marked with a*are required for the form to be submitted
Thank you for registering your Allergan breast implant concern with Leigh Day. Please note that we can only investigate your claim if:
 
  • The brand of implant used in your case was Allergan;
  • The type of breast implant used in your case was textured (i.e. Allergan Microcell or Biocell implants);
  • Your Allergan implant procedure took place in England and Wales; and
  • You were not given any warnings and/or advised of the risk of BI-ALCL at the time of implantation.
  • You are now worried about the risk of BI-ALCL developing or already have a diagnosis of BI-ALCL
  • You were implanted with your Allergan implants within the last 6 years; or have had your Allergan implants removed within the last 3 years; or have a removal appointment scheduled for the near future
 
If you satisfy the above criteria, please do go ahead and register your concern with us by completing the form below.

 

A. Contact information


Find your address by entering your post code in the below field.
If you can not find your address please enter your address in the Address fields provided.

B. Implant information

If your answer to question 6 is ‘smooth’ we will not be able to proceed with your enquiry as we are investigating claims relating to textured implants only.

If your answer to question 7 is not Allergan then, at the moment, your claim does not fit within the group of claims that we are building. However, if you would still like to register your details, please continue to do so. In the event that the claim is extended to include other implant brands, including the brand implanted in your case, we will be in touch.

If you answered 'other' to this question please provide some details in the next field

If your answer to question 10 is ‘No’, unfortunately due to jurisdictional reasons we will not be able to proceed with your enquiry. We recommend that you approach alternative solicitors within the jurisdiction where you had the surgery.

C. Your concerns

If you answered 'Yes' to question 15 unfortunately we will not be able to assist with your claim, and we recommend that you approach alternative solicitors.

If you answered 'other' to this question please provide further information in the following field

D. Key Dates

Please enter in the dd/mm/yyyy format
Please enter in the dd/mm/yyyy format
Please enter in the dd/mm/yyyy format
If you answered yes to this question please give the date in the following field
Please enter in the dd/mm/yyyy format
If you answered 'yes' to this question please provide the date in the next field
Please enter in the dd/mm/yyyy format

E. Cost

Implantation

Enter only figures in the field
Enter only figures in the field

Removal

Enter only figures in the field

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