Interventional Radiology / Interventional Oncology & Embolization / Embold Detachable Coil System / Case form submission

EMBOLD™ Fibered Coil case submission form

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Physician first name*

Physician last name*

Submitted on behalf of physician by (first and last name)

Email*

Hospital/clinic*

Case summary

Please do not provide any patient identifiable information or information that you are not appropriately authorized to share.

Patient presentation*

Intervention used*

Outcome*

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Upload "after" image*

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