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Hospital Adminstrators






 
 
   


For an estimate of the annual cost of using the ADAPt™ system in your facility, please complete the following information:

Name:
Title:
Hospital/Hospital Group:
Telephone:
E-mail:
Current Trocar Manufacturer:


Approximate number of laparoscopic cases per month, for both general and gynecological surgery: 

# of 5mm ports used in the last month: 

# of 10mm ports used in the last month: 

# of 12mm ports used in the last month: 

Thank You.    


 

 

 
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