Linea Systems appreciates your willingness to refer a qualifying patient.
We require your consent. You are willing to share your contact information with LINEA System, affiliates, and participating research clinics. You agree to be contacted by a patient coordinator, and if you are eligible and you enroll in the Victorion-Inception cholesterol lowering study, you agree to allow LINEA System to share identifiable information with participating clinics in your local area. See Full Consent Statement
By clicking consent you agree that you have obtained the patient consent to be contacted by a Patient Coordinator to further evaluate their eligibility to participate in this trial.
At the end of the form click submit referral. If you do not have the patient's phone and email address at this time, simply enter their name at the top of this form and a site liaison will contact your office by the next business day to obtain contact information.
You’re providing the opportunity to your patients to participate in this cholesterol lowering study for those that meet the following eligible criteria.
Please check the box next to each qualifier confirming you agree that the patient
meets that criteria.