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Traveling With Your Defibrillator
Frequently Asked Questions
Register Your Clinic

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Register your Clinic for Medtronic's Traveling Website

Please complete this form to have your clinic included in the Medtronic Traveling Website.
Thank you for your participation.


About the registrant
(this information is kept private)
  First Name
Last Name
E-Mail

About the clinic
(this information is made public on the Medtronic Traveling Website)
  Contact Name(s)
Clinic Name
Street Address
Street Address (cont.)
City
  State/Province
  Country
Zip/Postal Code
Phone
Clinic E-Mail
Website URL
 
Yes No
 Does your clinic follow patients with Medtronic Pacemakers?
Yes No
 Does your clinic follow patients with Vitatron Pacemakers?
Yes No
 Does your clinic follow patients with Cardiac Resynchronization devices (e.g. InSync)?
Yes No
 Does your clinic follow patients with Defibrillators?
Yes No
 Does your clinic follow patients with Reveal®?
Yes No
 Does your clinic use the Medtronic CareLink® Network?
 
Authorize Check the box on the left to signify that your clinic has a 9790 or Medtronic CareLink™ Programmer (2090), and that you are authorized to give permission for Medtronic to list your clinic on the Traveling Website(s).