FibroScan Unit Intake · Verialign™ Medical
Deal Team 12. Fill this out on every owner call, one practice per form. Everything you enter goes straight to the office.
Our websites (share with the practice if they ask)
Veritas Financing Group: https://veritasfinancing.group
Verialign™: https://verialign.ai
Integrity Medical Systems: https://integritymed.com
Book a callback
Need a follow-up call with the practice owner? Book it here while you're still on the phone. Pick a time, enter the owner's name and email, and they get the invite automatically.
Book a callback with Paul Cassano
Owner busy or call cut short? Click 'Save & email to finish later' at the bottom, enter the owner's email (or yours), and the link to finish this same form goes straight to their inbox. Nothing you've typed is lost.
1. Architect
Your name
*
Call date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
2. Practice and contact
Practice name
*
Contact name
*
Contact title
Please Select
Owner
Physician / Owner
Practice Manager
Office Manager
Medical Director
Administrator
Partner
Other
Other title
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Street address
City
3. The unit
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Model
*
Please Select
FibroScan 430 Mini+
FibroScan 502 Touch
FibroScan 530 Compact
FibroScan 630 Expert
Other / not sure
Serial number
Year purchased
Software / features
VCTE (liver stiffness, standard)
CAP (fat measurement)
SmartExam
SSM (spleen stiffness)
Guided VCTE
Not sure (owner will check)
Probes and options included
M probe
XL probe
S probe (pediatric)
CAP (fat measurement)
Spleen (SSM)
Cart / accessories
Condition
*
Please Select
Working fully
Working with issues
Not working
Not sure
How it's used now
Please Select
Used regularly
Used rarely
Idle / in storage
Last service date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Service contract
Please Select
Yes
No
Not sure
Ownership
Please Select
Owned outright
Financed (lien)
Leased
Not sure
If financed or leased, who and approximate payoff
Photos of the unit and serial plate
Upload a File
Drag and drop files here
Choose a file
Cancel
of
4. The offer
Seller's asking price
Our offer
Seller's response
Please Select
Interested
Thinking it over
Countered
Accepted
Declined
Their counter
Stay inside the numbers from your training. Never quote above your top.
5. Expansion: new equipment
Interested in new equipment?
Please Select
Yes
Maybe
No
Timeline
Please Select
Now
Within 3 months
3 to 12 months
Not sure
What equipment?
Would they want financing?
Please Select
Yes
Maybe
No
Do they have specific equipment in mind?
Please Select
Yes
No
Not yet
What equipment? (type, make/model, if known)
6. Next step
Callback booked?
Yes
No
Next step
*
Please Select
Send to the office for pricing
Call back
Send paperwork
Not interested
Follow-up date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes
Save & email to finish later
Submit intake
Should be Empty: