Biologics 900T - Contact Registry

Please take a few moments to fill out our Contact Registry. Complete as much as you can.
The more information you can give us, the better we can serve you.

Name:

Company:

Address:

City State: Zip:

Phone: Fax:

Country: Email:

Which of the following categories
best describes you:


How should we contact you?


What type of follow-up would you prefer ? (select all that apply)

Schedule a meetingPhone callLiteratureDemonstration


Which products of our products interest you? (select all that apply)

Biologics 900TBiologics Micro-miniSpecialty Foam Mattress


Please describe your purchasing influence. (select all that apply)

Final Say Recommend Influence DecisionNone


Which best describes your time frame for purchasing Biologics products?

ImmediatelyIn one monthIn three monthsIn six monthsOne year or more


How did you hear about us? (select all that apply)

Word of mouth

HME News

Extended Care Product News

Ostomy / Wound Management Magazine

Journal of WOCN Magazine

Provider Magazine

Long-term Care Magazine

Independent Living Provider Magazine

PT Journal

Advanced PT / OT

OT Weekly

Med Trade '97 Show

Med Trade '97 Directory

Thomas Register

Link From Other Web Page

Internet Search Engine

Other


Additional Comments:

 

Biologics, Inc.
33 North Garden Avenue, Suite 875
Clearwater, Florida 33755
(800) 821-6341 (USA-phone)
(727) 446-0605 (phone)
(727) 443-0631 (fax)

Bio900T@aol.com