New Client Form

Client Name* (example: Dr. Jane Doe)

Hospital/Clinic Name (if applicable) (example: Dog & Cat Hospital)

Phone Number*(example: 310-123-4567)

Email Address* (example: doctorjane@website.com)

Your Password

Confirm Password

Shipping Address*(example: 123 Center Drive, City, State, 90232)

Billing Address* (if different from shipping) (example: same as shipping)

Date*

Cartesian Medical - New Project Form

*required

What service are you interested in?* Virtual surgical planning consultation3D printed servicesResearch servicesTeaching assets

What is the level of urgency for this case?* Elective/Non-urgentUrgent (Cartesian representative will reply within 24 hours)

Project information:

Tell us a bit about your project (scope, goals, etc)*

Example: I have a 1 year old sheltie with bilateral short radius syndrome with subluxation of the left elbow. I took a CT scan and
would like a model printed of the left radius ulna through mid-humerus to plan surgical correction. I am interested in having
custom drill guides created as well. Ideally surgery would be scheduled in the next month.

Patient/Project Name* (example: Buddy’s left elbow)

Patient weight (kg) - if applicable

Patient date of birth - if applicable

Patient breed/species - if applicable

Diagnostics performed?* None (No problem! Ask us to send over positioning and calibration guides)RadiographsCTMRI

Please send downloadable links to imaging or other information to info@cartesianmedical.com