Biomet® Link Information Request Form

Contact Information
Practice Name*
First/Last Name*
Title*
Address
City
State
Zip
E-mail*
Phone
Practice Demographics
How many Doctors are in your practice?*
What are the primary specialties of the physicians in your practice? Foot/Ankle General Hand/Wrist Knee Shoulder/Elbow Spine Total Joints
*Which best describes your bracing practice with regard to the processing of braces/supports? (choose one)** Refer all braces and support fittings to an external provider via prescription Use a stock and bill service Purchase braces and bill using a third party billing service Purchase braces and bill using in-house staff
How are your practice's high end braces handled? (choose one) In-House Referred Outside
Additional questions or comments
How many locations does your practice have?*