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SELL YOUR EQUIPMENT

Need pricing or information on our products and services? Please fill out the form below and click submit.

Hospital/Company*

Name*

Email*

Phone*

What product are you interested in selling?*

Quantity

Additional information

RENTAL EQUIPMENT FORM

Our industry demands a great deal of flexibility. As a result, we are pleased to offer full inventory availability for rental and rent-to-own programs.

Hospital/Company*

Name*

Email*

Phone*

What product are you interested in?*

Your message*

RMA REQUEST

Hospital/Company*

Contact Name*

Phone*

Email*

PO#

Items To Be Sent In For Repair

What type of equipment will be sent?*

Model Number(s)*

Serial Number(s)*

Quantity*

Product Issue (Please describe in as much detail as possible)*

QUOTE REQUEST

Need pricing and information on one of our products? Please fill out the form below and click submit.

Hospital/Company*

Name*

Email*

Phone*

What product are you interested in?*

Your message*

CUSTOMER SURVEY

Who was your sales representative?

How knowledgeable did your sales representative seem to you? *

Very

Quite

Slightly

Not at all

Not Applicable

How satisfied are you with your equipment purchase? *

Very

Quite

Slightly

Not at all

Not Applicable

How prompt were our representatives with providing updates on your order or repair? *

Very

Quite

Slightly

Not at all

Not Applicable

How quick did you feel the turnaround time was on your equipment repair? *

Very

Quite

Slightly

Not at all

Not Applicable

How satisfied are you with the quality of our repair work? *

Very

Quite

Slightly

Not at all

Not Applicable

How well do you feel your order was packaged for shipment? *

Very

Quite

Slightly

Not at all

Not Applicable

How satisfied are you with our selection of inventory? *

Very

Quite

Slightly

Not at all

Not Applicable

Overall, how satisfied are you with Gopher Medical? *

Very

Quite

Slightly

Not at all

Not Applicable

How likely is it that you will use Gopher Medical again for your medical equipment needs? *

Very

Quite

Slightly

Not at all

Not Applicable

How likely is it that you will recommend Gopher Medical to a friend or colleague? *

Very

Quite

Slightly

Not at all

Not Applicable

Hospital/Company *

Your name *

Email *

Phone

Additional comments or suggestions

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NOTICE

** Gopher Medical does not accept returns. Gopher Medical reserves the right to offer refunds, credits or other consideration, accompanied by a restocking fee, in select circumstances at its sole discretion.

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REQUEST A QUOTE

Need pricing or information on our products and services? Please fill out the form below and click submit.

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CONTACT US

CONTACT US

Win a $20 Visa Gift Card!

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