Add an Account - Vidan Diagnostics

Add an Accounttx3602026-02-27T15:04:26-06:00

Initial Contact Date

Region

Account Manager

Prime Distributor

Distributor

Distributor Rep

Distributor Rep Email

Distributor Rep Phone

BHB Instrument Manufacturer

BHB Instrumentation

BHB QC Type Bi-level/Tri-level?

Currently Run BHB YES/NO?

BHB Proiciency Survey CAP/API?

PCT Instrument Manufacturer

PCT Instrumentation

Currently Run PCT YES/NO?

PCT Proiciency Survey CAP/API?

Customer Type Direct/Distributor?

Bed Size

Health System

Account

Sub-Health System

Address

Street Address Address Line 2 City State Zip Country

Number of Contacts

Contact

Email

Phone Number

Extension

Secondary Contact

Secondary Email

Secondary Phone Number

Extension

BHB Reagents/ Month

Please enter a number from 0 to 5.

BHB Reagents Annual Rev

BHB Controls/ Month

Please enter a number from 0 to 5.

BHB Controls Annual Rev

Bi-Level

BHB Controls Annual Rev

Tri-Level

BHB Linearity/ 6 Months

Please enter a number from 0 to 2.

BHB Linearity Annual Rev

PCT Reagents/ Month

Please enter a number from 0 to 5.

PCT Reagents Annual Rev

PCT Controls/ Month

Please enter a number from 0 to 5.

PCT Controls Annual Rev

PCT Calibrators/ Month

Please enter a number from 0 to 5.

PCT Calibrators Annual Rev

LucidPlus Strips/ Month

Please enter a number from 0 to 5.

LucidPlus Strips Annual Rev

LucidPlus Controls/ Month

Please enter a number from 0 to 5.

Lucidplus Controls Annual Rev

BHB Total Annual Rev

PCT Total Annual Rev

LucidPlus Total Annual Rev

Account Total Annual Rev

Pipeline Stage

Probability

Forecast Stage

Go Live Date

Date Last Contacted

Follow-up Date

Qcnow User YES/NO?

Notes