The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

SmsK5jWonMTr38XH46jiFab4cnV5h7LPktvnTF9o7z6FBgCGFVcnMuKzHDAWYj5s5yjIhyVqjHEKFCqTAnYufZrEZYJJxU9

The Wisconsin Chiari Center Physician Referral Form

Dear Doctor:

The Wisconsin Chiari Center can assist you in determining whether or not your patient warrants an investigation to exclude the Chiari malformation. We can answer questions regarding the type of investigation or imaging that is required and about different treatment options. You may be confused by certain controversies regarding diagnosis and treatment. If you have a patient that has undergone treatment for a Chiari malformation and has ongoing complaints you may wish to understand the significance of these complaints and treatment options for them. We are here to answer your questions.

If you would like Dr. Heffez to contact you regarding a patient, or to answer questions about Chiari Malformation, please complete the secure form below.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.