Site Survey

    • Billing Information

    • Clinical

    • Shipping Information

    • Accounts Payable

  • Additional Clinical Personnel

  • List Alternate Contacts (to receive confirmation notices):

    • Products of Interest

  • TPS Info

  • *Machine name has to match the TPS name. **If you have multiple machines, please contact .decimal for proper set up.
  • Required for Bolus ECT

    In order for us to properly setup your account, we must obtain the energy and its respective R90 depths for your machines.
  • Survey Wrap Up

    Any additional things you like to share, use this section.