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VITAL SPARK HEALTHCARE SOLUTIONS, INC.

Thank you for visiting our booth. We'd like to ask for a few minutes of your time to answer a few questions that may help us provide you with your current or future needs.

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Booth Registration Form

Title *

Name *

First Name • Middle Initial • Last Name

Position *

Company / Hospital Affiliation *

Address Line 1 *

Address Line 2

Contacts

Telephone

Mobile *

Email *

Preferred Contact Method

Mobile Email

You may select one or both.

Do you have any current or future need for the following? (Check all that apply)

Power Injector Power Injector Consumables Medical Grade Monitor Ultrasound Paper Diagnostic Workstation Medical DICOM Printer Contrast Media Mammography Radiation Protection Devices (e.g. vest, thyroid shield, etc.) X-RAY upgrade from analog to digital None

Do you have any current or future need for the following MR Conditional / MR Compatible Devices? (Check all that apply)

Ferromagnetic Detection System MR Incubator MR Anesthesia Machine MR Pulse Oximeter MR Patient Monitor MR Ventilator MR Infusion Pump MR Stretcher MR Wheelchair MR IV Stand MR Fire Extinguisher MR Oxygen Tank MR Oxygen Level Monitor Other MR requirement NONE

Would you like us to get in touch with you or any representative from your company / hospital / institution?

Yes No

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All submissions are saved in data/submissions.txt