Put essure as the product and Conceptus as the manufacturer. Just put in the date you had them put in and the result of your HSG if you had one. Don't worry about all the places. I think they give you 3 places to type in your own words. Just use the first section and say that you had essures placed in ??? and had HSG on ??? and now you are pregnant. There is place where you put your personal info in and they can contact you if they need to. You also need to request that your doctor that you are currently using to also make a report. The doctors don't seem to want to make the reports that is why I am advising that you go ahead and make one yourself.



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