New Line Epimed Essentials: Save up to 50% Off!

Cryo Painblocker™: Setting a New Standard in Cryoneuroablation - EXPLORE

2023 Reimbursement Guide - LEARN MORE

(972) 373-9090 myorder@epimed.com

Products
Physician Services
Medical Device Manufacturing
Resources
About
- Find a Rep
- Careers
- Locations
- New Account
- Contact
My Account
- Manage Payments

Select Page

Login

Invalid Credentials

Username

Password

Remember Me

Forgot Password

×

×

"*" indicates required fields

Step 1 of 5

20%

This application is for facilities and practices located in the United States and Canada only. For all other countries, please Contact Sales.

This form is for United States and Canada applicants only. Non-US applicants should contact sales to learn more. Approvals can take up to 5 business days and additional information may be requested.

Clinic/Hospital Name*

Billing Address*

City*

State*

Zip*

Country*

Email for Invoices*

Buying Affliation*

Examples: HCA, Novation, etc.

Federal ID*

Tax Exempt*

Is the facility exempt from paying sales tax?*

Yes

No

Hidden

Preferred Shipping*

Our FedEx Account

Our UPS Account

Epimed's FedEx

Epimed's UPS

Hidden

Carrier Account No.*

Upload Tax Exempt Certificate*

Accepted file types: pdf, png, jpg, Max. file size: 1 MB.

Site Security SSL

IHR-530 Rev. 13

Please provide a primary shipping address.

Shipping Address*

City*

State*

Zip*

County*

Country*

Telephone*

Fax

Site Security SSL

IHR-530 Rev. 13

Primary A/P Contact*

Phone*

Email*

Add more contacts?*

Yes

No

Please select:

Purchasing Agent

Materials Manager

Nurse

Risk Manager

Other Contact

Purchasing Agent

Phone

Email

Materials Mgt

Phone

Email

Nurse

Phone

Email

Risk Manager

Phone

Email

Other

Phone

Email

Site Security SSL

IHR-530 Rev. 13

Physician Office*

City*

State*

Postal Code*

Country*

Email*

Telephone*

Fax

Site Security SSL

IHR-530 Rev. 13

Physician First Name*

Physician Last Name*

Degree*

Pain Practice Specialty*

Site Security SSL

IHR-530 Rev. 13

Name

This field is for validation purposes and should be left unchanged.

×

Step 1 of 2

50%

Account Login - Request Quote
Contact First Name*
Contact Last Name*
Contact Email
Please select all that apply:*
- Please send a brochure to the email provided.
- If available, how do I get a sample?
- Have my local sales rep contact me.
- Please provide a price quote for this product.
- Please add me to Epimed News to stay informed
Quote Quantity:*

Physician First Name*
Physician Last Name*
Facility Practice Name*
Hidden
City*
Hidden
State Region*
Hidden
Country
Address
City State / Province / Region Country
Message
Email
This field is for validation purposes and should be left unchanged.

×

Online Access Features

24/7 Convenience
View & Print Invoices
Get Tracking Numbers
Account & Tax ID
Tax & Shipping Destinations
Billing Address
Billing Email Management
Online Payments
Submit Proof of Payment

Get Our Emails

Sign up to receive Epimed emails on new products, events, exclusive content, and more!

First Name*
Last Name*
Email*
Email
This field is for validation purposes and should be left unchanged.

About Epimed
Contact
Account
Privacy Policy
Terms of Use
Make a Payment

Physician Services
OEM Manufacturing
Media Resources
Products
Reimbursement
Find a Rep

Pain Medicine
Regional Anesthesia
Radiation Safety
Radiofrequency
Cryoanalgesia
Simulation

Facebook
Twitter
Instagram
LinkedIn
YouTube

© Epimed International, Inc. All Rights Reserved.

Follow us:

Chat with usLiveChat