Request a Consultation

Consultation Request for IVC Filter Removal

To request a consultation, please flll out the below form. We are happy to provide you the best quality care we can.

Patient's name*:

Patient's date of birth*:

Phone number:

Patient's primary care provider:

Reason filter was placed:

Prior failed attempt at retrieval?:

Yes No

Is patient on anticoagulation (also known as blood thinners):

Yes No

Best time to contact patient?:

Morning Afternoon Evening

Has the patient been seen at the University of Utah or Huntsman Cancer Institute in the past?:

Yes No

Or Call 801-581-2957