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BiPAD LOGO

To create innovative solutions that enhance the ability
of surgeons to heal.

BiPAD® REQUEST TO TRIAL

IN THE OPERATING ROOM

This is a request to trial our product during surgery (Human Use)

 

We are happy to know that you want to trial BiPAD® and we look forward to your feedback. Please send completed forms to trial.request@bipadsurgical.com.

CONTACT INFORMATION:

*Required Information

SHIPPING INFORMATION:

  • Shipping is charged separately.

  • All items will ship by FEDEX Ground unless noted.

  • Order must be placed by 2 PM ET for next day arrival.

Shipping Options

PURCHASE ORDER INFORMATION:

A $0 Purchase Order is required to send product. Please upload a Purchase Order to have your trial processed quickly. If BiPAD should follow up with another person for the P.O., please provide the contact information below. 

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Upload P.O.
Upload supported file (Max 15MB)

BILLING INFORMATION:

TRIAL DETAILS:

One trial provided per surgeon complimentary.  If additional product is needed, please put the quantity needed below and an invoice will be sent to you.

Generators Planned for Use:

Do you need an adapter cord for your machine?

*A Y Adapter is provided complimentary with your trial if needed. If a purchase is made it is yours to keep at no charge. If no purchase is made 30 days after the trial, a charge of $199 will automatically be billed to you unless returned to BiPAD Surgical, 110 Ocean Blvd, Point Look Out, NY 11569.

Surgeon(s) who will trial BiPAD at your facility:

How did you hear about BiPAD®?

Thank you. Your request for O.R. trial has been received.

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