MedTech for Solutions

GPO Application

Click here to download the MedTech Group Purchasing Organization (GPO) Application now

or fill out the application below:

Practice/Participant Name
Practice Physician Name
Contact Name
Medical Speciality
Distributor Designation
Acct #
Rep’s Name
DEA Number
Street Address
City
State
Zip
Phone
Fax
Email Address
Web Site
Total number of Physicians
Practice Type
Number of Surgery Suites
Surgical Specialty
Number of Physicians
Number of Procedures/Month