Background Image
Biomet
One Surgeon. One Patient.
 

Biomet® Link™ Hospital Lead Submission
(To be completed by a Biomet Sales Representative)

: Complete the form below, then click the Submit button. A Biomet® Link™ team member will review your request and contact you shortly.

*Required
Sales Representative Information
First/Last Name*
Phone Number*
Email Address*
PTM/IA*
RVP*
Has your PTM/IA been contacted regarding this account?  Yes  No
Has your RVP been contacted regarding this lead?  Yes  No
Hospital Information
Facility Name*
Address*
 
City*
State*
Zip Code*
Trauma Level
Number of Beds (200 minimum)
Number of ER visits annually (50,000 minimum)
Existing CareFusion Client Yes  No
Out-patient divisions interested in?
ER Surgical Center Orthopedics Family Practice Neurosurgery
Urgent Care Pediatrics PT/OT Rehab Services OB/GYN
Podiatry OR Pain Management Rheumatology
Hospital Staff Targets
Materials Management CFO/CEO Value Analysis Committee
Clinical Coordinator ED Director Trauma Nurse
Does the hospital own an internal DME/HME facility?  Yes  No
If yes, name of the facility
Additonal questions or comments
  

© Copyright 2010 Biomet, Inc. All rights reserved.
Background Image