Customer Sign Up

For you convenience Impact Medical has provided this customer sign up sheet. Once completed and submitted, Impact Medical will respond with a customer number that is exclusive to your facility. This will allow you to begin the ordering process. Thank you for selecting Impact Medical.

[contact-form-7 id=”3876″ title=”Customer Sign Up Form”]

If you prefer to submit this form via fax or email, click here to download a copy. (PDF)