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THIS FORM IS TO BE COMPLETED BY THE OPERATING SURGEON AND MUST BE RECEIVED BY ZIMMER BIOMET SHOULD A REVISION SURGERY BE REQUIRED WITHIN TEN YEARS (10 YEARS) OF PRIMARY IMPLANTATION OF A PARTIAL OR PRIMARY KNEE REPLACEMENT IMPLANT DUE TO THE ASEPTIC LOOSENING OF THE ZIMMER BIOMET PARTIAL OR PRIMARY KNEE REPLACEMENT IMPLANT (HEREINAFTER REFERRED TO “ASEPTIC LOOSENING”) WHERE THE ZIMMER BIOMET BONE CEMENT USED IN THE PRIMARY IMPLANTATION WAS NOT INFUSED WITH ANTIBIOTICS, AS OUTLINED IN THE BONE CEMENT WARRANTY TERMS AND CONDITIONS.

THE FORM MUST BE COMPLETED AND SUBMITTED TO BONECEMENTCLAIM@ZIMMERBIOMET.COM WITHIN THIRTY (30) DAYS FOLLOWING THE REVISION SURGERY IN ORDER FOR THE BONE CEMENT WARRANTY TERMS AND CONDITIONS TO BE EFFECTIVE.

FOR ADDITIONAL QUESTIONS OR INQUIRIES ON THE BONE CEMENT WARRANTY AND HOW TO COMPLETE THIS FORM, PLEASE E-MAIL BONECEMENTWARRANTYQUESTIONS@ZIMMERBIOMET.COM OR REACH OUT TO YOUR ZIMMER BIOMET SALES REPRESENTATIVE. 

Claim Form Instructions:

Step 1: Download and save the claim form to your device
Step 2: Open the claim form from your saved location on your device and complete the form within the interactive document
Step 3: Save, print, sign and send the form along with all supporting documents and imagery to: bonecementclaim@zimmerbiomet.com

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This material is intended for health care professionals.  Distribution to any other recipient is prohibited.
For product information, including indications, contraindications, warnings, precautions, potential adverse effects and patient counseling information, see the package insert and information on this website. To obtain a copy of the current Instructions for Use (IFU) for full prescribing and risk information, please call 1-800-348-2759, press 4 for 411 Technical Support.