Medical Device Order Request

Submit your hospital's medical device requirements with our streamlined ordering system. Our team will review your request and contact you shortly.

New Order Request

Complete the form below to request medical devices for your facility

1
Hospital Info
2
Contact Details
3
Device List
4
Review & Submit

Submitting your order...

Hospital Information

Enter the full name of your hospital or healthcare facility
Hospital name is required
e.g., Emergency, ICU, Cardiology (optional)
Complete address where devices should be delivered
Delivery location is required

Contact Information

Contact name is required
Valid email is required
Phone number is required

Medical Devices Required

Any special requirements, delivery instructions, or comments

Order Summary

Fill in the form to see your order summary

Important Notice

By submitting this request, I confirm that the information provided is accurate and represents a genuine clinical requirement. This submission does not constitute a legally binding purchase order. Final confirmation and pricing will be issued by DAS MedHub upon review of this request.