Aortic Disease Center for Medical Professionals

Make a Referral

This form is intended for healthcare providers to refer patients to the Aortic Center of University Hospitals Harrington Heart & Vascular Institute. To refer a patient for any other heart or vascular related service, call our scheduling team at 216-844-3800.

Please fill out the form below with your name and information and we’ll contact you for more information on your patient.

Provider First Name

Provider Last Name

Provider Email Address

Provider Telephone

Patient Name

Relationship to Patient

Patient information or description of referral

Condition(s) for Referral (check all that apply)

Abdominal aortic aneurysm

Ascending thoracic aortic aneurysm

Descending thoracic aortic aneurysm

Thoraco-abdominal aortic aneurysm

Type A aortic dissection

Type B aortic dissection

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