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Please complete the form below to provide your input regarding the Nikotab System.

Account Name:  
Email Address:  
Contact:  

1. What make of diagnostic ECG equipment do you use?
     
    Quinton/Burdick    HP/Philips GE Marquette
    Mortara Brentwood    Shiller/Welch Allyn
    Other  

2. Compared with the electrodes you are currently using,
    how would you rate the Nikotab System?

     
      The Nikotab System is…
    Better    Same    Not as good

3. Which factors(s) most influence your purchasing decisions
    for disposable ECG Electrodes?     (Check all that apply)
     
    Cost Quality    Ease of Use
    Brand Name    Local Distribution

4. Which other ECG procedures are performed in your office?
    (Check all that apply)

     
    Stress Holter Echo
    Pacing    Rehab