Worksheet for Pre-Course Planning - Biomed Support Services

Skip to navigation Skip to content

Home
About Us
Services
Course Info
Testimonials
Contact Us

Home
About Us
Services
Upcoming Events
Course Info
Media
Testimonials
Contact Us

Search for:

Pre-Course Planning Worksheet
*An asterisk denotes a required field.
Contact Information
Requestor Name*
First Last
Job Title*
Phone Number*
Email - Requestor*
Enter Email Confirm Email
Hospital Name*
Hospital Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Training Event
Training Date(s)*
Course Options*
- One Day Course - $5,095
- Two Day Course - $6,495
- Three Day Course - $7,895
- Four Day Course - $9,295
- Five Day Course - $10,695
Select the number of days above and then the course(s) from the options below. The price listed is the same for up to five students. Each additional student is $395 per student.
One Day Course*
- LigaSure Vessel Sealing Generator
- Force EZ Electrosurgical Generator
- FT10 Energy Platform
Number of Students*
Two Day Courses*
- Force FX -C
- ForceTriad
Number of Students*
Three Day Courses*
- Force FX -C & ForceTriad
- Force FX -C & FT10
- ForceTriad & FT10
Number of Students*
Four Day Courses*
- Force FX -C, ForceTriad & FT10
Number of Students*
Five Day Courses*
- Force FX -C, ForceTriad, FT10 & Force EZ
- Force FX -C, ForceTriad, FT10 & LigaSure
Number of Students*
Training Equipment
It is required that the hospital provide the electrosurgical generators (type and number) for training. We recommend one generator for every three students.
Will you be able to meet this requirement? (If no, there will be a charge of $300 per generator)*
- Yes
- No
Biomed Support Services provides generator rentals. If you are interested in this option, please select how many of each generator you would like us to bring.
Force FX -C*
- 0
- 1 (+ $300)
- 2 (+ $600)
- 3 (+ $900)
- 4 (+ $1200)
- 5 (+ $1500)
ForceTriad*
- 0
- 1 (+ $300)
- 2 (+ $600)
- 3 (+ $900)
- 4 (+ $1200)
- 5 (+ $1500)
FT10*
- 0
- 1 (+ $300)
- 2 (+ $600)
- 3 (+ $900)
- 4 (+ $1200)
- 5 (+ $1500)
Rental Charge Agreement*
- I understand that the rental fee is in addition to the cost of training and will be charged as a separate line item on the invoice. This extra charge may require an amendment to the NTE amount specified on the original purchase order.
Shipping/Training Facility
Point of Contact*
First Last
Work Phone*
Cell Phone*
Email - Point of Contact*
Enter Email Confirm Email
Building Name*
Building Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Does this facility have a shipping dock?*
- Yes
- No
If yes, does the dock have a lift gate/plate?*
- Yes
- No
Specific delivery and pick-up hours?*
Can the training equipment crate arrive early?*
- Yes
- No
Recommended airport*
Is there a security check-in requirement?*
- Yes
- No
If yes, explain*
Is the in-house WiFi accessible?*
- Yes
- No
If yes, how?*
Comments
Payment Information
Total
$0.00
The total price reflects course options, generator rentals and additional students over five.
Payment Method*
Purchase Order #*
If you have questions submitting a PO please call 303-525-3393.
Credit Card #*
No dashes.
Name on Credit Card*
Expiration MM/YY*
Credit Card Code*
This field is hidden when viewing the form
Agree To Terms*
- I have read and agree with the Cancellation Policy

Search for:

Meta

Log in
Entries feed
Comments feed
WordPress.org

Contact Us:

2631 Crooked Vine Ct
Colorado Springs, Colorado 80921

303-525-3393

Recent Comments

Archives

Links:

Home
About Us
Services
Course Info
Testimonials
Contact Us

Categories

No categories

Stay in Touch:

If you’d like to be notified of upcoming classes or changes in instructional content, please add your email to our list.

Email*
This field is hidden when viewing the form
Section Break
CAPTCHA

© Biomed Support Services 2025