Request For QRS

* Required

* First Name

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* Last Name

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* Phone

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* Email

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* Name of Facility

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* Country

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* Address

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* City

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* Do you belong to a purchasing group?

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Describe Service Needed

Services	Check all that apply	Number of Cases
Random Case Quality Cardiovascular Review for AUS and Overall Quality		Value must be a whole number
Client Selected Cardiovascular Case Review		Value must be a whole number
Comprehensive Focused CV Review as in FPPE/OPPE		Value must be a whole number
Onsite Physician Consultant Cardiovascular Quality Review Services		Value must be a whole number
Onsite Consultant Review / Support (Non-physician)		Value must be a whole number
Remote CV Case Review Conference		Value must be a whole number
Remote CMO Consultation / Support		Value must be a whole number
Custom CV Quality Review Services		Value must be a whole number

Or Contact Our Office at:(202) 657-6859 or email us at info@cvexcel.org

Accreditation for Cardiovascular Excellence (ACE)
T: 804-639-9213 info@cvexcel.org

* Message:

Thank you