NEW - Master the Racz Procedure: WATCH our Guide!
Epimed Essential Nerve Block Needles & Epidural Needles - Explore our New Line - LEARN MORE
Tropocells® PRP - The New Generation of PRP Systems - LEARN MORE
Cryo Painblockerâ„¢: Setting a New Standard in Cryoneuroablation - EXPLORE
2024 Reimbursement Guide - LEARN MORE
(972) 373-9090
myorder@epimed.com
Products
Catheters
Racz® Catheters
VERSA-KATH®
Neo-Kathâ„¢ Set
G-21 Epidural Catheterâ„¢
FETH-R-KATHâ„¢
SPIROL® Catheter
VIEW ALL
Nerve Block Needles
Blunt Nerve Block Needles
BELLA-D® Needle
STEALTHâ„¢ Nerve Block Needle
Day Needle
Blunt Access Cannula (BAC)
Quincke Needles
Chiba Needles
VIEW ALL
Radiofrequency
Accura-Câ„¢
Cobra RFâ„¢
RFâ„¢ Sharp Needles
Stainless Steel RFâ„¢ Probes
RFâ„¢ Grounding Pad
RFâ„¢ Probe Sterilization Tray
Ruloâ„¢ RF System
VIEW ALL
Epidural Needles
RX-2™ Coudé®
RX Epidural Needles
Flexible Introducer Cannula (FIC)
R.K.â„¢ Epidural Needles
Tuohy Epidural Needles
Trays and Kits
Racz® Catheter MiniTray
Tuohy Single Shot Kit
VIEW ALL
Accessories
Stingray® Connector
NEXUSâ„¢ Connector
Epidural Flat Filter
VIEW ALL
Epimed Essentials – Volume Pricing
Essential Quincke Nerve Block Needles
Essential Tuohy Epidural Needles
Radiation Safety
Protection Gloves
Ready-To-Go Apron
Flex X-Ray Apron
Flex Vest & Skirt X-Ray Apron
VIEW MORE
Charts and Models
GENESIS Injection Simulator
THORAXIS Neuraxial Simulator
SPINALIS Injection Simulator
Spine Models
Anatomical Charts
ALL SIMULATORS
Cryoneuroablation
Tropocells® PRP
Physician Services
Reimbursement
Fellowship Lecture
Lunch and Learn
Medical Device Manufacturing
Resources
About
Find a Rep
Careers
Locations
New Account
Contact
My Account
Manage Payments
Select Page
Components
Racz® Catheter MiniTray
Racz® Catheter MiniTray with Plastic LOR, available with Brevi-Kath, Brevi...
read more
×
×
"
*
" 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
This field is hidden when viewing the form
Preferred Shipping
*
Our FedEx Account
Our UPS Account
Epimed's FedEx
Epimed's UPS
This field is hidden when viewing the form
Carrier Account No.
*
Upload Tax Exempt Certificate
*
Accepted file types: pdf, png, jpg, Max. file size: 1 MB.
IHR-530 Rev. 13
Please provide a primary shipping address.
Shipping Address
*
City
*
State
*
Zip
*
County
*
Country
*
Telephone
*
Fax
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
IHR-530 Rev. 13
Physician Office
*
City
*
State
*
Postal Code
*
Country
*
Email
*
Telephone
*
Fax
IHR-530 Rev. 13
Physician First Name
*
Physician Last Name
*
Degree
*
Pain Practice Specialty
*
Terms and Conditions
*
By creating an account on Epimed, I agree to the
Terms and Conditions
.
IHR-530 Rev. 13
Name
This field is for validation purposes and should be left unchanged.
×
Step
1
of
2
50%
- 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.
This field is hidden when viewing the form
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
*
This field is hidden when viewing the form
City
*
This field is hidden when viewing the form
State Region
*
This field is hidden when viewing the form
Country
Address
City
State / Province / Region
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Message
By requesting a quote, you agree to receive marketing emails from Epimed. You may unsubscribe at any time.
Name
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