SURN ITNM Registry — Provider Portal

1

Register your site Complete the form below — 2 minutes

2

Share enrollment link with patients Post QR or share link at point of care

3

Patients complete surveys Baseline → 12 mo — $10 gift card per survey

4

View your outcomes dashboard Implant counts, device types, complications & outcomes

Eligible devices: Revi™ • eCoin™ • Altaviva™ • Other FDA-approved iTNM

Patient eligibility: Age 18+, has received an iTNM implant, able to read English, has email/phone for reminders

Why Participate?

Minutes to join. Instant access to outcomes data for your patients.

📊

Your Outcomes Dashboard

Implant counts, device breakdown, complication rate, and validated outcomes (OAB-Q, PGI-I) — your patients only.

🎯

Quality Improvement Data

Use your site's outcomes scorecard for QI — no extra data collection.

🤝

National Benchmarking

Compare your outcomes to national trends as the registry grows.

📖

Research & Authorship

Contributing sites are eligible for authorship on registry publications.

surn-itnm-site/dashboard.html

Dr. Jane Smith, MD — General HospitalData as of May 2026

12

Patients

11

Implanted

4

12-mo Done

12

Enrolled

7

Revi™

3

eCoin™

1

Complic.

8

Improved

Implants by Month

Device Mix

Overview

Outcomes

Patient List

Complications

Patient ID	Device	Status	PGI-I
PT-001	Revi™	12-mo Done	Much Better
PT-002	eCoin™	6-mo Done	Very Much Better
PT-003	Revi™	3-mo Done	A Little Better

Demo data — your real dashboard is sent to you by email after registration

See what your dashboard looks like

Your personalized outcomes dashboard link is sent to you by the study team after registration. It shows your site's implant counts, device breakdown, complications, and validated outcomes.

Preview Dashboard →

Ready to join? Register your site ↓

Provider Registration

Takes 2 minutes. The study team will follow up within 1–2 business days.

👤 Provider Information

First Name *

Last Name *

Credentials *

Specialty

Institution / Practice Name *

Practice Address

📞 Contact Information

Email *

Office Phone *

Cell Phone (optional)

Preferred Contact Method *

Email Office Phone Cell Phone

👥 Preferred Contact Person (optional)

I have a coordinator or staff member for study communication

📄 Site Details

Which iTNM device(s) do you implant? *

Revi™ eCoin™ Altaviva™ Other FDA-approved iTNM

Approximate implants per year

Comments (optional)

Patient Recruitment

Share the link or hand patients the flyer at the point of care.

📄 Patient Materials

⬇ Download Patient Flyer (.docx) 📱 Open Patient Enrollment Site

🦾 What Patients Find at the Site

✓Plain-language study overview and eligibility
✓Survey timeline — baseline through 12 months
✓Types of questions to expect
✓$10 gift card per survey (up to $50 total)
✓Privacy information and link to REDCap consent

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