Medserv Healthcare Solutions
Request a PulseQ Proposal
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Name
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Company Name
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Phone
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Email
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Address
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How Many AEDs are we bringing into the PulseQ Program ?
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List your current AED Models:
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Zoll Powerheart G5 (Cardiac Science)
Zoll Powerheart G3 (Cardiac Science)
Phillips
Heartshine
Physio Control
DefibTech
Other
Would you like us to propose you a Trade In with a NEW AED
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YES
NO
How soon are you ready to Sign up ?
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Immediate
In 1 - 2 months
Other
Please enter any additional requirement information you wish
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