Physician Referral TAVR Consultation Form

If you have a patient suffering from heart disease due to severe aortic stenosis that you believe may be a candidate for transcatheter aortic valve replacement (TAVR), you may refer to our Valve Clinic through EPIC under CT Surgery or please complete and submit this online form and fax the patient's most recent echocardiogram with a fax cover sheet to: 

Valve Program Coordinator
Fax: 262-928-5301







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