Medical Information Request Form
All fields are required – incomplete forms will be returned
VenaCure EVLT System
Other: Please specify in text field below
AngioDynamics Sales Representative
†By initialing and submitting this form, I certify that this request for information was not solicited in any manner by an AngioDynamics’ representative. All requests will be reviewed and processed in accordance with AngioDynamics’ policies and procedures – AngioDynamics reserves the right to reject any submitted Medical Information Request form.