| Contact Information | |
|---|---|
| First Name | Amy |
| Last Name | Theis |
| Address | 1180 East Ave. NE |
| City | Bemidji |
| State | MN |
| Province | |
| Zip/Postal Code | 56601 |
| Country | United States |
| Home Phone | 218 - 760-3134 |
| hope16_05@yahoo.com | |
| Alternate Email | hope16_05@hotmail.com |
| Website Address | www.freewebs.com/bpimn |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Amy - Theis |
| Date of Injury | 02/21/1987 |
| Type of Injury | Obstetric |