Add a Badge

<<< Back to Manage Account

The clinic will be charged for the additional badge on a pro-rated basis.

If you wish to add a fetal badge please use the Fetal Badge Request Form

	* denotes required fields
Dealer Account Number
Dealer P.O. Number
Clinic P.O. Number
*Clinic Name
*Primary Contact
*Clinic Phone Number
*E-Mail
*Start Date For Badges:

Add the Following Employees:

*Employee Name

*SS/Employee ID

*DOB (XX/XX/XXXX)

*Badge Type

Comments