Please complete this request form and an ARA team member will get in touch with you to set up a consultation about your uterine fibroids and how UFE might help. During the consultation, we will assess your symptoms to see if you might be a candidate for uterine fibroid embolization, a leading-edge, non-surgical way to treat uterine fibroids that causes them to shrink drastically. Uterine fibroids are benign (noncancerous) tumors that grow on or within the muscle tissue of the uterus. Approximately 20-40% of women 35 years and older have fibroids. Often fibroids are symptom-free but because of size or placement in or around the uterus they may cause severe symptoms that can affect the quality of your life. Heavy bleeding, pain, frequent need to urinate, constipation, and bloating are some of the ways that uterine fibroids can make your life miserable.Name* First Last Age* Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*NameThis field is for validation purposes and should be left unchanged.