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SVS PSO Bard® LifeStent® Treatment of Popliteal Artery Disease Project Site Questionnaire
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Contact Information                                                                                            
The lead physician is responsible for supervision of the Quality Improvement Project data collection at the site.
                                                                                                                                                               Lead Physician First Name   *
Lead Physician Last Name *
Physician Email *
Physician Phone Number *
Physician Institution *
Do you currently participate in the Vascular Quality Initiative (VQI)? *
Do you currently participate in the Peripheral Vascular Intervention (PVI) Registry? *
Data Abstractor                                                  
The Primary Data Abstractor is responsible for accurate data entry or the VQI project at all time points at the site as determined by the Lead Physician.  The data abstractor will serve as the day-to-day point of contact during the conduct of the project.                        
Data Abstractor First Name *
Data Abstractor Last Name *
Data Abstractor Email *
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