VA PURCHASE Inquiry ThermaZone Thermal Therapy Device

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* 1. Please provide your contact information

First & Last Name

State/Province

Email Address

Phone Number

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* 2. How did you hear about ThermaZone?

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Facebook

Instagram

VAMC

Clinician

Family/Friend

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* 3. Please confirm if you are a Veteran

No

Yes. Please provide associated VAMC

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* 4. Do you have an existing ThermaZone unit?

No, I do not have a ThermaZone Unit

YES, I have a ThermaZone Unit

Please provide the year of when the unit was received:

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* 5. Please list which pad(s) and/or accessory you are interested in:

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* 6. Can we send you the latest product news, articles, and offers?

Yes

No