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IMPROVE CLINICAL PERFORMANCE IN THE MRI SUITE

 Please take a few minutes to answer the following questions so that we can respond appropriately to your request.

* First Name:
* Last Name:
* Title:
* Hospital Name:
* Address:
* City:
* State:
* Zip:
* Phone:
* Email Address:

1. *Are you:

2. *If you are planning to investigate a purchase, why are you doing it at this time?

3. *What make/model ventilator did you last purchase?
4. *How old is your fleet of ventilators?

5. *Is this a purchase you will be able to make?

6. *Who within the hospital would be the key person involved in making this decision?
7. *Is there a time line or deadline for your decision?

8. Please tell us about any special requirements or needs you have at your hospital. (250 characters max)
* = Required Field
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