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Shunt Catheter Assembly Tool - Interest Form
Thank you for expressing interest! We are currently assessing the interest in ordering such a tool and would appreciate your feedback.
- The Shunt Catheter Tool Team
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Lastname, Firstname
*
Your answer
E-mail
*
How can we reach you?
Your answer
Would you be interested in ordering this tool for your institution or clinical practice?
*
Yes
No
If yes, how many tools do you anticipate ordering?
1
2
3
4
5 - 10
10 - 15
15+
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Job title
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Place of work
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City/town
Your answer
Country
Your answer
How did you find out about this tool?
Publication
Website
Word of mouth
Article
Other:
Additional comments
Please let us know if you have comments regarding the tool. All feedback is greatly appreciated!
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