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Name*

Phone*

Email*

Which device do you want to acquire?*

How many ultrasounds do you refer now per day(before acquiring the device)?*

How many ultrasounds do you expect to perform per day after acquiring the device?*

How many HbA1c and lipid profiles do you refer now per day(before acquiring the device)?*

How many HbA1c and lipid profiles do you expect to perform per day after acquiring the device?*

How many WBC tests do you refer now per day (before acquiring the device)?*

How many WBC tests do you expect to perform per day after acquiring the device?*

How many Hb tests do you refer now per day (before acquiring the device)?*

How many Hb tests do you expect to perform per day after acquiring the device?*

How many full hemogram/CBC tests do you refer now per day (before acquiring the device)?*

How many full hemogram/CBC do you expect to perform per day after acquiring the device?*

How many biochemistry tests do you refer now per day (before acquiring the device)?*

How many full biochemistry tests do you expect to perform per day after acquiring the device?*

How many biochemistry tests do you refer now per day (before acquiring the device)?*

How many full biochemistry tests do you expect to perform per day after acquiring the device?*

How do you want to pay for your device*

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How do you want to pay for your device*

How much do you plan on charging customers for a test with the device?*

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