Are You A Candidate For EECP® Therapy?

Present this completed survey to your physician/nurse practitioner/physician assistant.

Enhanced external counterpulsation therapy is a non-invasive treatment for angina. Answer the questions below to see if EECP® therapy might be right for you. After completing the form, you have the option of printing the form and presenting it to your physician/nurse practitioner/physician assistant or you may submit it, and we will forward it to your doctor by email.


Check off the symptoms that affect you:

*(denotes required field)






















If you answered “Yes” to any of the above questions, you may be a candidate for EECP therapy.
To locate a treatment center near you, please click here > Locate EECP Treatment Centers



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