Ultravet has finalized a prototype of the CoApt Valve® and in final stages of laboratory animal testing with clinical animal testing imminent (50 implants/50 controls). If you are interested please fill out the Clinical Trial Eligibility Registration Form below and click submit.

UltraVet Medical Devices Clinical Trial

Eligibility Registration Form

Owner's Name

First Name

Last Name

Email Address

Street Address

Patient's Name

Date of Birth

Weight

Breed

Primary Vet's Name and Phone Number

Has Patient been Evaluated by a Board Certified Cardiologist?

Yes

No

If Yes, Name and Number of Cardiologist

Has Your Dog Been Hospitalized with Congestive Heart Failure?

Yes

No

If Yes, When? (If More Than Onece, Please List All Hospilization Dates

When Was the Patient's Last Echocardiogram?

Is the Patient on any Medication or Supplements?

Yes

No

If Yes, Please List All Dosages and Start Dates

Has the Patient Been Diagnosed with Any Other Diseases?

Yes

No

Is Yes, What and When?

CoApt™ ValVe Clinical Trials

UltraVet Medical Devices Clinical Trial

Eligibility Registration Form