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Home
Products
All Products
Hospital Cable Management
Medical Cable Tethers
Wire Baskets
IV Poles & Accessories
Custom Solutions
About
Clinical Evaluation
Privacy Policy
Return Policy
Capability Statement
Cleaning Instruction
Quote
Contact
Vendor Request Form
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Clinical Evaluation
Request a Trial
Request a Trial
Request a Trial
Clinical Evaluation Program
Request a Secure Mount Trial
Interest in evaluating Secure Mount at your facility? Fill out the form below and our team will contact you to discuss your needs and determine an appropriate trial setup for your facility.
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*
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Contact Information
Name
*
First
Last
Job Title / Department
*
Hospital / Health System Name
*
Email Address
*
Phone Number
Tell Us About Your Trial
Which Secure Mount Products Are You Interested In?
*
Select all that apply.
Cable Tethers
Antimicrobial Tethers
Heavy-Duty Tethers
IV Pole Products
Other
Please Describe
*
Which Departments Would Be Participating in the Trial?
*
Where Would You Like to Initially Evaluate Secure Mount Products?
*
One Department
One Hospital
Multiple Hospitals
Not Sure
Approximately How Many Units Would You Like to Evaluate?
*
What Would You Like to Accomplish With the Trial?
*
Select all that apply.
Reduce Cable Loss / Replacement
Improve Cable Organization
Reduce Equipment / Cable-Related Issues
Evaluate Secure Mount for Broader Implementation
Other
Please Describe
*
Additional Information
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By submitting this form, you are requesting information about the Secure Mount Trial Program. A member of our team will contact you to discuss your needs and determine the appropriate trial setup.
