COSMED - Installation/Training Request

Sunday, 26 May 2013

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Installation/Training Request Form

Installation/training request by

Name of company

First Name

Last Name

City

Country

Email

Installation/training site

Name of facility

Address of facility

City

State/Region

Country

Telephone

Email

Department

Responsible of Department

In which floor is the installation/training site ?

Is a freight elevator available on the installation/training building?

Yes
No

Please provide sizes of installation/training room door:

Does the facility have Wi-Fi or Internet connection available?

Yes
No
Don't know

Nearest recommended airport

Travel time from airport to installation facility

Installation/Training Requirements

Preferred date for Installation/Training

Available time for installation/training ? (hours/days)

What kind of training is required ? (check all apply)

Product Training (operation, calibration, software, ordinary maintenance)
Bioengineering training (service, on-site repair, parts replacement)
Application training (clinical background, in-depth methodology, test interpretation)

Proficiency in English language of the audience:

Advanced
Medium
Low/None

Preferred language of installation/training sessions:

Where are the products that need to be installed?

In warehouse with original packaging
In installation site with original packaging
In installation site already out of the box

Does the installation includes parts/components not provided directly by COSMED (ie PC peripherals)?

Yes
No
Don't know

If yes, please specify configuration

Expected Attendees

Number of expected attendance

Experience on the systems to be installed and on methodology

None
Limited
Average
High

Typology of attendees (check all apply)

Medical doctors	Nr.
Exercise Physiologists	Nr.
Phd/Students	Nr.
Respiratory Technicians	Nr.
Biomedical Engineers	Nr.
Nurses	Nr.
B2B dealers	Nr.
Other	Specify: Nr.

Additional comments

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