Complete this form to request a CANARX representative reach out to complete your enrollment in the program and place your first order. Please note that completing this form does not automatically enroll you in the program but it is the first step. By submitting this form, you authorize a CANARX representative to contact you directly to help complete your enrollment to this great program. Welcome to CANARX!
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Note: Please refrain from using generic terms such as “heart disease” as this could indicate any number of conditions such as valvular heart disease, heart failure, a bradyarrhythmia, a tachyarrhythmia, a ventricular conduction delay, etc.