VM Hospitals Form

First Name *

Last Name *

Title

E-mail Address *

Phone *

Organization

Clinical Area [check all that apply]

Cardiac CATH Lab
[EP Lab] Electrophysiology
[IR] Interventional Radiology
[OR] Operating Room
Other, Please specify

City

State

Zip

Country

How would you best describe your function?

Is your lab primarily a Diagnostic or Interventional lab?

What is your annual interventional procedure volume per year?

Are you currently using an Inventory Management solution?

I would like to receive additional WaveMark news and updates?

Yes
No

Would you be interested in reviewing a webinar (online presentation) of our solution(s)?

Yes
No

Primary Inventory challenges [check all that apply]:

Stock-outs of key items
Too much on hand
No time to manually count
Can't find expired products easily
Can't find recalled items easily

How did you hear about WaveMark?

Questions and Comments?