If you are considering including ArterioVision^TM in your practice or have any questions, please contact us at 760 837-4778 or by completing this form. 

* denotes required field

Name *

Please Select One ----> Cardiologist Endocrinologist Family Practice Internal Medcine Nephrologist Osteopath Urologist Vascular Medicine Nurse Nurse Practitioner Sonographer Office Manager Medical Staff Student Other Position

Phone *

E-Mail *

E-Mail (Please re-enter) *

Practice Name *

Please Select One ----> 1 2 3 4 5 6 7 8 9 10 11 - 19 20+ Number of Physicians - (if applicable, otherwise leave blank)

City *

Please Select -----> Non US (Type Country with City Above) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State *

Yes No Ultrasound at practice? *

Yes No Contact me for free demo?  *

Please Select a Date ----> Tuesday, December 3, 2024 Wednesday, December 4, 2024 Thursday, December 5, 2024 Friday, December 6, 2024 Saturday, December 7, 2024 Sunday, December 8, 2024 Monday, December 9, 2024 Before 7:00AM 7:00AM 7:15AM 7:30AM 7:45AM 8:00AM 8:15AM 8:30AM 8:45AM 9:00AM 9:15AM 9:30AM 9:45AM 10:00AM 10:15AM 10:30AM 10:45AM 11:00AM 11:15AM 11:30AM 11:45AM 12:00PM 12:15PM 12:30PM 12:45PM 1:00PM 1:15PM 1:30PM 1:45PM 2:00PM 2:15PM 2:30PM 2:45PM 3:00PM 3:15PM 3:30PM 3:45PM 4:00PM 4:15PM 4:30PM 4:45PM 5:00PM 5:15PM 5:30PM 5:45PM 6:00PM 6:15PM 6:30PM 6:45PM 7:00PM 7:15PM 7:30PM 7:45PM 8:00PM After 8:00PM EST/EDT CST/CDT MST/MDT PST/PDT   Best time to contact? *

Please Select a Date ----> Tuesday, December 3, 2024 Wednesday, December 4, 2024 Thursday, December 5, 2024 Friday, December 6, 2024 Saturday, December 7, 2024 Sunday, December 8, 2024 Monday, December 9, 2024 Before 7:00AM 7:00AM 7:15AM 7:30AM 7:45AM 8:00AM 8:15AM 8:30AM 8:45AM 9:00AM 9:15AM 9:30AM 9:45AM 10:00AM 10:15AM 10:30AM 10:45AM 11:00AM 11:15AM 11:30AM 11:45AM 12:00PM 12:15PM 12:30PM 12:45PM 1:00PM 1:15PM 1:30PM 1:45PM 2:00PM 2:15PM 2:30PM 2:45PM 3:00PM 3:15PM 3:30PM 3:45PM 4:00PM 4:15PM 4:30PM 4:45PM 5:00PM 5:15PM 5:30PM 5:45PM 6:00PM 6:15PM 6:30PM 6:45PM 7:00PM 7:15PM 7:30PM 7:45PM 8:00PM After 8:00PM EST/EDT CST/CDT MST/MDT PST/PDT  2nd Best time?

Please Select a Date ----> Tuesday, December 3, 2024 Wednesday, December 4, 2024 Thursday, December 5, 2024 Friday, December 6, 2024 Saturday, December 7, 2024 Sunday, December 8, 2024 Monday, December 9, 2024 Before 7:00AM 7:00AM 7:15AM 7:30AM 7:45AM 8:00AM 8:15AM 8:30AM 8:45AM 9:00AM 9:15AM 9:30AM 9:45AM 10:00AM 10:15AM 10:30AM 10:45AM 11:00AM 11:15AM 11:30AM 11:45AM 12:00PM 12:15PM 12:30PM 12:45PM 1:00PM 1:15PM 1:30PM 1:45PM 2:00PM 2:15PM 2:30PM 2:45PM 3:00PM 3:15PM 3:30PM 3:45PM 4:00PM 4:15PM 4:30PM 4:45PM 5:00PM 5:15PM 5:30PM 5:45PM 6:00PM 6:15PM 6:30PM 6:45PM 7:00PM 7:15PM 7:30PM 7:45PM 8:00PM After 8:00PM EST/EDT CST/CDT MST/MDT PST/PDT  3rd Best time?

Please Select One ----> Alltheweb AltaVista America Online AOLFind Ask Jeeves Excite Google Go Goto Hotbot Infoseek Lycos MSN Northern Lights Snap Web Crawler Yahoo Banner Ad Friend Website News Group Magazine/Newspaper Radio Other Found us where? *

Comments/Questions:


Please type the text displayed in the image. *
Change Image


 

Medical Technologies International, Inc.

Tel/Fax: 760.837.4778 

Email: info@i-mti.com  •  Web: www.i-mti.com