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* Indicates a required item
* First Name:
* Last Name:
* Institution:
* Address:
* City:
* State:
* ZIP Code:
Office Telephone:
Fax:
* E-mail:

1. Type of practice:
Solo
Group (3 physicians or more)
Partnership (2 physicians)
Hospital

2. Which of the following do you plan to acquire for your practice?
 
within
3 months
within
12 months
• Cervical cancer screening
• Colposcope
• Contraceptive devices
• Cryosurgery equip.
• Electrosurgery equip.
• Endometrial ablation
• Endometrial sampling instruments
• Fertility products
• Fetal monitoring equip.
• General medical svcs.
• Hormonal contraceptives
• Hysteroscopy equip.
• Hysterosonography
• Labor/delivery equip.
• Laparoscopy equip.
• Lasers, all
• Medical education svcs.
• Medical software
• Osteoporosis equip./prod.
• Prenatal prod./svcs.
• Test kits/pregnancy tests
• Ultrasound
• Urodynamics equip.
   

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