REQUEST A QUOTE

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?*

Your message*

REQUEST A QUOTE

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?*

Your message*

Win a $20 Visa Gift Card!

Our customer satisfaction is of the upmost importance to us. Please take a few moments to let us know how we’re doing. You will be entered in our monthly drawing for a chance to win a $20 VISA gift card!

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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)*

Do you need a shipping label?*
(Does not apply to dealers or rental returns)
YesNo

Return ship to address:

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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CONTACT US

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.

Thank you for your message. It has been sent.

There was an error trying to send your message. Please try again later.

REQUEST A QUOTE

REQUEST A QUOTE

Win a $20 Visa Gift Card!

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