First-Call Medical, Nationwide 24-Hour Holter, Event, Pacemaker & Blood Pressure Monitoring
 

E-Mail Request Form

To enroll in the First-Call Medical service and request your overnight delivery of equipment, supplies, and instruction manuals fill out the form below.

There is no capital investment necessary and you will not be asked for any credit card information.

Indicate the Recording / Monitoring Equipment and the Quantities you Require:
Qty Equipment
Mobile Cardiac Telemetry Monitor self contained recording and transmitting unit
Heatrak Smart pre and post symptom cardiac event monitor
Heartrak post symptom cardiac event monitor
Digital Holter Monitor 24 hour monitor
Ambulatory Blood Pressure Monitor 24 hour blood pressure monitor
 
Check the box next to the Items you require:
Mobile Cardiac Outpatient Telemetry
Heatrak Smart
Heartrak
Digital Holter
Twentyfour 24 Hour Ambulatory Blood Pressure Monitor
Billing Codes
Supplies
Cardiac Event Monitoring Supplies
Cardiac Event Monitoring Instruction Manuals
Cardiac Event Monitoring Case Studies Diagnosis Codes Billing Codes
Holter Monitoring Supplies
Holter Monitoring Instruction Manuals
Holter Monitoring Case Studies Diagnosis Codes Billing Codes

Fill out the following contact information:

Account Name:
Contact Person:
E-Mail Address:
Phone Number:
Fax Number:
Mailing Address:
City, State & ZIP:
Start date:
Specialty:
Unique Physician Identification Number:

Do you require any additional information?:

Thank you


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