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Practitioner Profile

Please complete the Practitioner Profile and acknowledge the statement regarding your electronic signature below.
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Practice Address: Spectranetics will confirm your practice address prior to shipping materials
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Required Field I currently utilize the excimer laser for:  Cardiac Lead Extraction
 Coronary Artery Disease
 Peripheral Artery Disease
 I am not a current user
 Other (please specify below)
 
Required Field Please indicate the exact nature of your off-label request:
In compliance with FDA guidelines, I submit my name, practice
information and email address as an electronic signature.
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