Elsevier

Requestor Information:

Number of Residents in Program

(if requesting for Residency Program)

Stryker Representative Name

**Please contact your Stryker sales representative before requesting textbook(s) ***

Request Information:

1.

Active HCP License/NPI #

Is this textbook related to the practice of medicine in the CMF space? Yes No

Active HCP License/NPI #

Is this textbook related to the practice of medicine in the CMF space? Yes No

Active HCP License/NPI #

Is this textbook related to the practice of medicine in the CMF space? Yes No

Certification: *By submitting this form you confirm the certification statements listed below.

Certification: *By submitting this form you confirm the certification statements listed below. * I have the requisite authority to submit this request. I have ensured that all institutional and departmental requirements are met and, that the acceptance of textbook(s) is allowable. Stryker Craniomaxillofacial may be required to disclose this information under federal and state transparency laws. The acceptance of the educational textbook(s) does not create any obligation on the part of any person or entity to purchase, prescribe, order or otherwise make use of (or arrange for or recommend the use of) Stryker products Stryker Craniomaxillofacial does not endorse the educational textbook(s) or practices/procedures in which the educational textbook(s) may describe.

Name and Title

If submitted by a teaching institution, must be authorized by Program Director or Resident Coordinator.

Certification: Requests from teaching institutions, must be authorized by Program Director or Resident Coordinator

If submitted by resident or fellow please provide name and title of personnel who authorized you to submit request.

Authorizer's name and title

Cookies are used by this site.

Terms and Conditions Privacy Policy Cookie Notice

Requestor Information:

Request Information:

1.

2.

3.

Certification: *By submitting this form you confirm the certification statements listed below.

Certification: Requests from teaching institutions, must be authorized by Program Director or Resident Coordinator