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

Patient presentation*

Intervention used*

Outcome*

Upload "before" image*

Upload "after" image*

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