Perio TEE Interest Form

Thank you for your interest in the IAC Perioperative Transesophageal Echocardiography accreditation program.
If your facility is interested in applying for Perioperative Transesophageal Echocardiography when the application becomes available, please complete the following form.

Please Note: This is not the application for accreditation. After submitting this interest form, facilities will be contacted with details to begin the accreditation process when the application is released.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Is your facility currently accredited by IAC in any other modality?*

YesNo
If yes, please enter your current IAC application number(s).*
Please select which area(s) you are currently accredited in by IAC:*

Adult EchocardiographyPediatric EchocardiographyOther
Should be Empty:

Thank you for your interest in the IAC Perioperative Transesophageal Echocardiography accreditation program.