Participate in the Mabu Heart Failure Trial

Thank you for your interest in participating in the Catalia Health Wellness Coach pilot. For our current pilot we are looking for people who have heart failure to try Mabu in their home. Please complete this form so that a member of our team can contact you.

By submitting this form you consent to sending some health-related information to Catalia Health. We strive to protect our patients’ information and will only use this information to determine your eligibility for the program and to better understand where you are on the spectrum of health and disease. The information will not be used for any other purposes.

Your Name *

Your answer

E-mail address *

Your answer

Phone number *

Your answer

Location (city, state) *

Your answer

Best time to be contacted (optional)

Your answer

Do you have heart failure?

Yes

If yes, what year were you diagnosed? *

Your answer

Submit

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