Please answer the following questions for us to begin planning your ASC.

First Name *

Last Name *

Email *

Phone *

Surgery Center Name *

Address

Will a warming cabinet be needed for blankets or fluids? *

Will an ice maker be needed? *

Will an AED (e.g., Zoll AED Plus) or a defibrillator (e.g., Zoll R-Series) be needed? *

Will a video tower needed? *

Will a shaver be needed? *

Will a liposuction machine be needed? *

Will an infusion pump or syringe pump be needed? *

Will a laser be used? If so, what type of laser should be available? *

What type of laser will be used? *

Will a Bair Hugger patient warmer be needed? *

Do you need to upload any files? *

We will be reviewing the information provided to best provide youw with an equipment plan!

Have a great day!

We will be reviewing the information provided to best provide youw with an equipment plan!

Have a great day!

Halyard Drape, Split, EENT, 76" x 124", Sterile, 10/cs

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