Corporate & Clinic Event Inquiry
Complete the form to share your event details and needs.
Full Name
*
First Name
Last Name
Organization / Clinic Name
*
Role / Title
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Location / City
*
Estimated Number of Participants / Patients
*
Organization Type
*
Please Select
Physician Office
Functional Medicine Clinic
Concierge Medicine Practice
MedSpa / Wellness Studio
Corporate Wellness / Employer
Chiropractic / Medical Office
Wellness Event Organizer
Other
Preferred Event Type
*
Please Select
CIMT Cardiovascular Screening Day
Women’s Wellness Ultrasound Day
Executive Wellness Screening Event
A La Carte Ultrasound Day
Corporate Wellness Pop-Up
Clinic Imaging Support
Not Sure Yet
Preferred Event Date or Timeframe
*
-
Month
-
Day
Year
Date
Services Interested In
*
CIMT Screening
Carotid Screening
Thyroid Ultrasound
Abdominal Ultrasound
Kidney & Bladder Ultrasound
Breast Wellness Ultrasound
Transabdominal Pelvic Ultrasound
Diagnostic Ultrasound Exams
Other
Do you have a private room or space available for scanning?
*
Yes
No
Not Sure
Do you have access to a standard electrical outlet?
*
Yes
No
Not Sure
Message / Event Goals
Request Event Information
Should be Empty: