Start your collection service

Your center

Center name*

Facility type

Operating rooms taking partHow many rooms will collect.

Tax ID (EIN)We need this to pay you. Send it later if you do not have it.

Website

Parent companyYour health system or IDN, if you belong to one.

Accounts payable or admin email

Where we send containers and labelsStreet address*

Suite or floor

City*

State*

ZIP*

Other locationsList any other sites that will collect with you.

Surgical specialties you perform

This tells our warehouse which collection containers to build for you.

What you collect

Tick every device your center uses. Your containers are built from this list.

ICE cathetersSingle-use intracardiac echo catheters
IVUS and imaging cathetersPhilips Eagle Eye and Visions PV, Boston Scientific OptiCross
IVL cathetersShockwave - peripheral and coronary
Laser atherectomy cathetersAuryon

Harmonic and LigaSure devicesHarmonic ACE+7 and 1100 shears, LigaSure sealer-dividers
TrocarsEndopath Xcel

Who we contact

Name as many people as you like. The first person is our main contact. Everybody listed gets the monthly shipping reminder.

Main contact

Name*

Title or role

Email*

Phone

Contact 2

Name*

Title or role

Email

Phone

What they do

Anything else

How you prefer to hear from us

Special instructionsDock hours, where to leave the containers, who to ask for.