Short QT Syndrome


Physician Form

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This form is provided to allow physicians direct contact with Dr. Bjerregaard.

Please provide the following contact information:

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Select any of the following options that apply:

I want to report a new case of SQTS
I would like information on ongoing clinical studies
I want to discuss a case with Dr. Bjerregaard
I want to refer a patient to Dr. Bjerregaard's clinic

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Revised: 04/02/14

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