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Hospital Name*

No abbreviations please

Hospital Name*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What Get With The Guidelines® programs does your hospital currently participate in?

(select all that apply - hold ctrl key to select more than one)

What, if any, aortic stenosis/valve registries does your site currently participate in? *

What echocardiogram (ECHO) data surveillance software does your hospital currently utilize?

What is your hospital's annual transcatheter aortic valve replacement (TAVR) volume?

Main Contact(s): This may be the Site PI, Dept. Chair, Dept. Manger, etc. If there are multiple contacts, please provide a list of all, separated by commas.*

Email address(es)*

*If multiple contacts are listed above, please provide an email for each person, separated by commas.

Inquiry Type: *

What EHR or EMR systems are used in your hospital?*

Comment/Question*

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