ThermaZone Thermal Therapy Device DME Inquiry

Question Title

* 1. Please provide your contact information

First & Last Name

Company | Organization

State/Province

Email Address

Phone Number

Question Title

* 2. Please provide your company's website(s)

Question Title

* 3. Which of the following pain management device(s) do you currently carry? Please check all that apply.

DJO Global's Iceman

Ossur Cold Rush

Breg

Stryker

ThermoTek

ThermX

Nice

GameReady

Other (please specify)

Question Title

* 4. How did you hear about ThermaZone?

Family/Friend

Customer

Clinician

Business Referral

Advertisement (please specify)

Question Title

* 5. Where can you ship?

Nationally (All 50 States)

These following US State(s) only:

Question Title

* 6. Type of Facilities you serve. Please check all that apply:

Government/Military (ex. VA or DoD)

Physical Therapy Clinics

Chiropractic Clinics

Hospitals

Athletic Training (Professional Sports Team or Collegiate)

Other (please specify)

Question Title

* 7. Types of Patients your work with:

Worker's Comp

Private Insurance

No Fault Auto

Other (please specify)

Question Title

* 8. Are you interested in a rental program?

Yes

We already have an existing rental program and are interested in incorporating ThermaZone

ThermaZone Thermal Therapy Device DME Inquiry

Question Title

* 1. Please provide your contact information

Question Title

* 2. Please provide your company's website(s)

Question Title

* 3. Which of the following pain management device(s) do you currently carry? Please check all that apply.

Question Title

* 4. How did you hear about ThermaZone?

Question Title

* 5. Where can you ship?

Question Title

* 6. Type of Facilities you serve. Please check all that apply:

Question Title

* 7. Types of Patients your work with:

Question Title

* 8. Are you interested in a rental program?

Question Title

* 9. Can we send you the latest product news, articles, and offers?

Question Title

* 10. Please provide any questions or additional comments below: