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To create innovative solutions that enhance the ability
of surgeons to heal.

BiPAD® REQUEST TO TRIAL

IN THE OPERATING ROOM

This is a request to trial our product during surgery (Human Use)

 

We are happy to know that you want to trial BiPAD® and we look forward to your feedback. Please send completed forms to trial.request@bipadsurgical.com.

CONTACT INFORMATION:

*Required Information

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SHIPPING INFORMATION:

  • Shipping is charged separately.

  • All items will ship by FEDEX Ground unless noted.

  • Order must be placed by 2 PM ET for next day arrival.

Shipping Options
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PURCHASE ORDER INFORMATION:

A $0 Purchase Order is required to send product. Please upload a Purchase Order to have your trial processed quickly. If BiPAD should follow up with another person for the P.O., please provide the contact information below. 

Upload P.O.
Upload supported file (Max 15MB)

BILLING INFORMATION:

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TRIAL DETAILS:

One trial provided per surgeon complimentary.  If additional product is needed, please put the quantity needed below and an invoice will be sent to you.

Generators Planned for Use:

Do you need an adapter cord for your machine?

*A Y Adapter is provided complimentary with your trial if needed. If a purchase is made it is yours to keep at no charge. If no purchase is made 30 days after the trial, a charge of $199 will automatically be billed to you unless returned to BiPAD Surgical, 110 Ocean Blvd, Point Look Out, NY 11569.

Surgeon(s) who will trial BiPAD at your facility:

How did you hear about BiPAD®?

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