Outpatient Surgery
  Outpatient Surgery is free to qualified professionals. Summary Description
  To apply for a FREE subscription to Outpatient Surgery, please answer ALL of the questions on the form below.
  The magazine publisher determines qualification and reserves the right to limit the number of free subscriptions.
  Geographic Eligibility: USA


 
1. Do you wish to receive a FREE subscription to Outpatient Surgery?
Yes     No


First Name:
Last Name:
Degree:
  (MD, RSN)
Job Title:
(Ex: Director, Vice President, Project Manager, etc.)
Facility Name:
(Please provide your Company Name in full: abbreviations could disqualify you)
Mailing Address:
Department/Division:
City:
State:
Zip Code/Postal Code:
Country:
(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Telephone Number:
Fax Number:
Email Address:
(Note: Valid email address is required or you could be disqualified.)
Number of Steril ORs:
Number of Endoscopy Rooms:

  Which of the following best describes your industry? (select only one)


Please specify for Other:

  What is the approximate number of employees in your company? (select only one)
 
Yes, please auto-fill my contact information for other publication qualification forms.


2. Month of Birth:


3. Which best describes your professional title? (select only one)
Administrator / Director / Manager Director, Surgical Services / Director of Nursing
Medical Director / Chief Surgeon Anesthesiologist / Nurse Anesthetist
OR Manager / Supervisor Other


4. Which best describes the type of facility you are associated with? (select only one)
Acute-care Hospital Ambulatory Anesthesia
Licensed or Certified ASC Other
Office with Surgery Suite


5. I have influence over the purchase of: (select all that apply)
None Business Supplies & Services
Capital Equipment Surgical Supplies
Implants Surgical Pharmaceuticals


6. The facility I am associated with is located in: (select only one)
United States     Canada     Other


7. We serve the following specialty areas: (select all that apply)
All ENT
Dermatology General Surgery
Gastroenterology Ophthalmology
Gynecology Pain Management
Orthopedics Podiatry
Plastic Urology
Dental / Oral Surgery


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