KLASSIC HD® HIP SYSTEM LOANER OR CONSIGNMENT REQUEST FORM

PEER to PEER Requests

Surgeon Visitation, 1:1 Calls, Grand Rounds/Dinner Events
We want to understand the following so we can help you meet your goals:
1. Business Impact/Target - Who are you targeting, and what is the proposed impact on the business? What are the focus products?
2. Format/Setting/Dates - 1:1 Call, Surgeon Visitation or Dinner Event. What are the proposed setting and dates/timeline?
1) Business Impact/Target
Requestor Details*

First NameLast Name
Requestor Email*
example@example.com
Target Surgeon / Practice*
Products Currently Used*
Product Focus Area (Select all that apply)*

Aurum TechnologyKlassic KneeKlassic Hip / Platform CupEfficiency / Klassic ONEASCTHINK / TMINI Robotics
What is the expected impact of the event? What is the surgeon's current usage? *
2) Format/Setting/Dates
Type of Event Proposed (Select all that apply)*

Call / Virtual MeetingIn-person MeetingDinner Event / Grand RoundsSurgeon Visitation - Half DaySurgeon Visitation - Full Day
Preferred Days of the Week

MondayTuesdayWednesdayThursdayFriday
Preferred Dates
Preferred Surgeon Faculty / Visitation Site*

MICHAEL P. BOLOGNESI, MD – Durham, NCSHAWN B. HOCKER, MD – Wilmington, NCAARON A. HOFMANN, MD – Salt Lake City, UTKEITH G. HOLLEY, MD – Boise, IDJASON M. HURST, MD – New Albany, OHKENNETH B. MATHIS, MD – Houston, TXDAVID C. McNABB, MD – Raleigh, NCMICHAEL J. MORRIS, MD – New Albany, OHCHRISTOPHER E. PELT, MD – Salt Lake City, UTJONATHAN PETERSON, MD – Salt Lake City, UT
All submissions will be reviewed and responses will be provided within 48 hours. If you have questions, please contact the Marketing team.
TOTAL JOINT ORTHOPEDICS

MISSION-DRIVEN™

1567 East Stratford Ave.
Salt Lake City, Utah 84106
o. 888.890.0102 f. 801.486.6117 sales@tjoinc.com
Should be Empty:

PEER to PEER Requests

1) Business Impact/Target

2) Format/Setting/Dates