Request an Evaluation for the TAVR Procedure

You will need to provide confidential medical information to determine eligibility for the TAVR procedure. By proceeding through this notice and providing the requested demographic and medical information, you consent to the disclosure of such information to the relevant MedStar Washington Hospital Center clinical staff. The information that you provide will be placed into our electronic database. Your specific information will be accessed and used only for TAVR evaluation purposes. Aggregate data (without patient identifiers) may be analyzed at a later date. The information that you provide will not be shared with other organizations, and cookies or other tracers will not be used to collect information or track your computer use.

If you have any questions about TAVR, or if your heart condition changes a lot while you are waiting for the procedure, please call MedStar Heart Institute's TAVR Team, at 202-877-5975

Patient Information:
* Indicates required field
Patient's Name *
Address *
City *
State *
Zip *
Gender * Male Female
Contact Information:
Email Address
Daytime Phone *
Evening Phone *
Health Information:
Name of Cardiologist *
Have you been diagnosed with severe aortic stenosis?* Yes No
When was your last echocardiogram? *

110 Irving Street, NW · Washington, DC 20010 · MedStar Washington Hospital Center · (202) 877-7000