Get Started Now

Get answers to your questions about INR self-testing immediately by calling a Remote Cardiac Services' representative toll-free at 877-799-3132 (between 8:30am and 5pm EST).

Complete this form and we'll send you a package that includes:

Information on Medicare and other health insurance that has approved coverage for INR self-testing
Prescription form your doctor will need to complete before you enroll
Description of the easy-to-use INR meter and everything else you'll want to know before starting to test your INR at home

Patient Information

* First Name

* Last Name

* Address

* City

* State

* Zip

Telephone Number

Your Email address

* How long have you been on Coumadin or other anticoagulant medication?

Not taking it yet
Less than 3 months
Between 3 and 12 months
Longer than a year

* Why did your doctor prescribe this medication for you?

One of these reasons
Mechanical heart valve surgery
Chronic atrial fibrillation (AF)
Pulmonary embolism
Deep vein thrombosis (DVT)
Hypercoagulable state

All other reasons
hip, knee or other joint procedure

* We can help with your insurance questions and the enrollment process by talking with your doctor. May we contact your doctor?

Yes No

* Doctor Name

* Doctor Phone

* Your date of birth

// (Needed for I.D. purposes)

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