If you would like to find out more information about the MitraClip® device
and/or the EVEREST II clinical research study, please email us with your
questions, concerns and requests. Your message will be directed to the
appropriate person at Evalve, Inc. and we will respond directly.
All patient information provided in this form is kept confidential and
used only for the purposes of determining eligibility to participate in this study.
To help us serve you, please complete the following:
General Contact Info:
First Name
Last Name
Address 1
Address 2
City
State
Zip/Postal
Country
Phone
Email
Potential Patients:
Have you or someone you know been diagnosed with mitral regurgitation (MR)?
No
Yes
Myself
Someone I Know
Comment:
How did you hear about us?
Newspaper
Television
Internet
Radio
Family/Friend
Health Care Practitioner
Other
Message:
You may also want to write, phone or fax us at:
Evalve, Inc.
4045 Campbell Ave.
Menlo Park , CA 94025 , USA
Call (650) 330-8100 or
Fax (650) 330-8114
Within the United States: Investigational Device. Limited by United States law to investigational use. Within Canada: Investigational Device. To Be Used by Qualified Investigators Only – Instrument de recherche. Réservé uniquement à l'usage de chercheurs compétents.
This product is available for commercial distribution in the EU.
