Free Patient Information Kit - Learn More About PT/INR Self Testing

To speak directly with a Philips representative who can answer your questions about self-testing, please call the toll-free number at the right of your screen. Our offices are open between 8:30am and 6pm Eastern Standard Time.

For more information about PT/INR self-testing, insurance coverage and enrollment forms, please complete the form below. Please be assured that all information is held in strict confidence.

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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