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APL
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First name
*
Last name
*
Email
*
Birthday
*
Month
Month
Day
Year
Address
*
Time elapsed nice amputation
*
Sex
*
Man
Women
Marital Status
Single
Married
Carrent occupation
*
Activ worker
Stopped
Housewife
Retired
Level of amputation
*
Supracondyle or supragenius
Infracondylea or Infrageniana
Supramaleolar
Bilateral amputation
*
Yes
No
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VGK knee
VGK Technology
VGK Rrange
VGK-Go
VGK-S for short transfemoral
VGK-X for lightweight adult
VGK-XS for children
EXANEO feet
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