Super User Training Program Nominations

Physician Trainers, please complete the form in order to nominate a Super User for an upcoming training session.

* required fields

CathWorks Physician Trainer Email*

Medtronic Representative*

Medtronic Clinical Specialist

Account Name*

Account Number*

Date of First FFRangio Case at Account*

Total Number of FFRangio Cases Performed at Account*

Super User Nominee 1 - Name*

Super User Nominee 1 - Email*

Number of FFRangio Cases Performed by Super User 1*

Has Super User 1 Been Officially Certified?*

Super User Nominee 2 - Name

Super User Nominee 2 - Email

Number of FFRangio Cases Performed by Super User 2

Has Super User 2 Been Officially Certified?

Select Super User Training*

Additional Comments

Phone

This field is for validation purposes and should be left unchanged.