Contact Form
If you have a hard to heal wound and would like us to contact you with more information, please complete the brief form below.
Did You Know?
The average length of treatment for a wound healing patient is 61 days. Thus, if you have intentions of undergoing wound healing treatment, we recommend that you find a wound healing center near where you live, or, that you make short-term furnished housing arrangements close to where you will be obtaining your care.
Required Information
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First Name
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Last Name
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Email Address
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Main Phone
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Main Phone Is
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Home Number
Work Number
Friend or Relative's Number
Optional Information
Address
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Preferred method to contact you
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Issue/Problem Of Interest/Concern
(check all that apply)
Diabetic Wound Of the Lower
Extremity
Compromised Skin Grafts and Flaps
Delayed Radiation Injury
Necrotizing Soft Tissue Infections
Osteomyelitis (Refractory)
Crush Injury
Compartment Syndrome
Acute Traumatic Ischemias
Clostridial Myonecrosis (Gas
Gangrene)
Carbon Monoxide Poisioning
Decompression Sickness
Air Or Gas Embolism
Other (please explain below)
I am (check one)
a potential patient
seeking info for someone else
a physician
an Allied health professional
a Governmental/social services
rep
a Media rep
Other (please explain below)
Comments
[2,500 characters* Maximum (*letters, numbers and spaces)]
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240 Williamson Street, Suite 104 Elizabeth, NJ 07207 ph 908-994-5480 fx 908-994-8802
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