Name of Cardiologist
Phone Number of Cardiologist
Email address of Cardiologist
Name of Hematologist/Oncologist
Email address of Hematologist/Oncologist
Phone Number of Hematologist/Oncologist
Administrative Contact Person
Name of Institution
West Des Moines
How would you describe your institution?
Is your C-O program a dedicated C-O clinic?
How long has your cardio-oncology program been in operation?
On average how many C-O patients do you see each month?
Do you have any training program in C-O at your institution?
Have you become a member of IC-OS?
Did you take the IC-OS Certifying exam or did anyone at your practice?
What hematology/oncology or other subspecialties are regularly engaged with the C-O team (list the top 5)?
Hematology, Oncology, Radiation Oncology, Exercise physiology, Bone marrow transplant, Solid organ transplant, Pharmacy, Nursing leadership, Hospital Administration, Nephrology, Electrophysiology, Interventional Cardiology, Cardiac Imaging, Nuclear medicine, Radiology, Cardiomyopathy/Heart Failure, Arrhythmia including QT prolongation, Vascular toxicity (not including HTN), Thrombosis related toxicity, Myocarditis, Cancer Survivorship, Pre-chemotherapy or stem cell evaluation, Hypertension