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Refer a Patient for a Left Atrial Appendage Occlusion (LAAO) evaluation

Your patient is important to us. Thank you for partnering with Christian Hospital’s Structural Heart Program for further care of your patient.

Please complete and submit the form below to refer a patient for a LAAO procedure evaluation, including uploading the patient’s medical record. The medical record must have documentation regarding rationale for consult with Christian Hospital Structural Heart Program. Documentation of shared decision making with patient must be documented in the patient’s medical record.

Should you have any questions throughout this process or thereafter, please contact our office at 314.250.5599.

Criteria for Evaluation

Patient Information

Date of Birth

Insurance Information

Primary Insurance
Secondary Insurance

Referring Physician Information

Requested Records

Find a doctor or make an appointment: 800.392.0936
General Information: 314.653.5000
Christian Hospital
11133 Dunn Road
St. Louis, Missouri 63136

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