For Patients
Contact Us
(516) 277-9000
Open Menu
HEALTHCARE PROFESSIONALS
Medical Technology
RADIOFREQUENCY
Surgi-Max® Family
Surg-e Pak™
MINIMALLY INVASIVE SPINE
Disc-FX® System
Endoscopic Spine Systems
Surgi-Max Drill
Trigger-Flex® Family
Bi-Tip™
NEUROSURGERY
Micro Bipolar
Bipolar Forceps
Surgi-Max® Radiowave Accessories
Training and Workshops
U.S.A.
EMEA
South America
Clinical Education & Resources
Coding and Reimbursement
Clinical Literature
Visual Applications
Upcoming elliquence Webinars
PATIENTS
Disc-FX Overview
Understanding Endoscopic Spine Surgery
NEWS & EVENTS
News
Featured Stories
Testimonials From Medical Professionals
ABOUT
Overview
Quality Management System
Career Opportunities at elliquence
Warranty Registration
Customer Survey
Test Sign Up
Authorized and Non-Authorized Products
Contact
HEALTHCARE PROFESSIONALS
Medical Technology
RADIOFREQUENCY
Surgi-Max® Family
Surg-e Pak™
MINIMALLY INVASIVE SPINE
Disc-FX® System
Endoscopic Spine Systems
Surgi-Max Drill
Trigger-Flex® Family
Bi-Tip™
NEUROSURGERY
Micro Bipolar
Bipolar Forceps
Surgi-Max® Radiowave Accessories
Training and Workshops
U.S.A.
EMEA
South America
Clinical Education & Resources
Coding and Reimbursement
Clinical Literature
Visual Applications
Upcoming elliquence Webinars
PATIENTS
Disc-FX Overview
Understanding Endoscopic Spine Surgery
NEWS & EVENTS
News
Featured Stories
Testimonials From Medical Professionals
ABOUT
Overview
Quality Management System
Career Opportunities at elliquence
Warranty Registration
Customer Survey
Test Sign Up
Authorized and Non-Authorized Products
Contact
Disposables Order Form
All Orders Received after 3:30 pm EST are not guaranteed to ship the same day.
elliquence will cover ground shipping costs. The rep or facility is responsible for any shipping cost above the standard ground cost.
Disposable Order Form
Name
*
Name
First
First
Last
Last
Phone
*
Email
*
Ship To:
*
Ship To:
Ship To:
Ship To:
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Date Needed By:
*
Expected Return Date:
Trigger-Flex 31 (DTF-31)
Trigger-Flex 38 (DTF-38)
Trigger-Flex 40 (DTF-40)
Trigger-Flex Mini 31 (DTFM-31)
Bi-Tip (BT-FT)
Trigger-Flex Quad 18 (DTFQ-18)
Trigger-Flex Quad 24 (DTFQ-24)
Trigger-Flex Quad 31 (DTFQ-31)
Trigger-Flex Dart Short (DTFD-13)
Trigger-Flex Dart Long (DTFD-24)
Trigger-Flex Quad Pro (DTFQM-31)
16g Spine Needle (DFX-N6/1)
18g Spine Needle (DFX-N8/1)
Access Needles with Beveled Tip (N6-D4/1)
If you are human, leave this field blank.
Next
Start Over
Translate »