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Clinical Trial Enrollment

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This study is only open to people between the ages of 18-70 with a cardiologist and planning to have surgery in the next 90 days.

By submitting this form, you are expressing interest and asking for On-X Life Technologies and your local research facility to contact you via telephone or email to determine your eligibility in this trial.

Fields marked with an asterisk (*) are required. This information will only be used for the PROACT trial.

Please correct the items highlighted in red.

Full Name:*
Email Address:*
Phone Number:* - -
Heart Physician's Name:*
I do not currently have a heart physician.

I am between the ages of 18 and 70*

When do you anticipate having heart valve replacement surgery?*
- 0-90 days from now
- 90 days or later

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