Trudell Medical | Device Registration

First Name *

This field is required.

Last Name *

This field is required.

Email Address *

This field is required.

Address *

This field is required.

City *

This field is required.

Province *

This field is required.

Postal Code *

This field is required.

Who uses this product? *

This field is required.

Name of the user

This field is required.

What year was the user born? *

This field is required.

Device is used for treatment of:

This field is required.

Chamber Type *

This field is required.

Whose recommendation influenced you to use the device as part of your treatment? *

This field is required.

Was the cost of the device covered by any of your insurance programs? *

This field is required.

Comments

By registering, you consent to receive electronic communications from Trudell Medical International and its affiliates, including information about products, promotions, and services. You understand that you may withdraw your consent and unsubscribe at any time and have had the opportunity to read our privacy policy.