Customer Contact Form
Thank you for your interest in CELOX™ PPH.
Please complete the form below to help us understand your needs and how we can assist you.
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1.
Title
(Required.)
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2.
Name:
(Required.)
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3.
Clinic/Hospital:
(Required.)
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4.
Country:
(Required.)
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5.
Email Address:
(Required.)
6.
Phone Number:
7.
How did you hear about CELOX™ PPH?
8.
How many deliveries do you typically have at your hospital per year?
9.
How many cases of postpartum haemorrhage (PPH) do you typically have at your hospital per year?
10.
Are you currently using any medical devices or products to manage PPH?
Yes
No
If yes, which ones (please specify):
11.
What challenges have you experienced in managing PPH in your practice?
12.
What features and capabilities are you looking for in a medical device or product for management of PPH, and how do you prioritise these features?
13.
Please provide any additional information or questions you may have:
*
14.
Would you like any follow up, visit or further information on CELOX PPH?
(Required.)
Yes
No
If yes, please specify:
