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MEDSETUP SYSTEMS LLC
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Intake form
Help us serve you better
Name
*
Email address
*
What type of healthcare facility do you represent?
Select
Hospital
Clinic
Private Practice
Nursing Home
Rehabilitation Center
Urgent Care Center
What type of medical equipment are you interested in?
Please select at least one option.
Diagnostic Equipment
Surgical Equipment
Therapeutic Equipment
Monitoring Equipment
Support Equipment
What is your preferred method of contact?
Select
Phone
Email
In-person
What is your budget range for the medical equipment?
Select
Under $5,000
$5,000 - $10,000
$10,000 - $20,000
$20,000 - $50,000
Over $50,000
What is the timeline for equipment procurement and setup?
Select
Immediate
Within 1 month
1-3 months
3-6 months
More than 6 months
Please specify any specific brands or models you prefer.
Do you require training for your staff on the new equipment?
Select
Yes
No
Maybe
What additional services do you require?
Please select at least one option.
Equipment Maintenance
Staff Training
Technical Support
Procurement Coordination
Regulatory Compliance Assistance
Additional questions or comments
Submit
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