Get the free TheraSphere Order Form Customer Service Telephone: 1-866-363-3330

OCT 16TheraSphere Order FormCustomer Service Telephone: 18663633330Please complete this form and email to theraspherecustomersupport×btgplc.com or fax to 18002685299 (North America) or16134824843.

How to fill out therasphere order form customer

How to fill out therasphere order form customer

1. To fill out the TheraSphere order form, follow these steps:
2. Start by entering the customer's personal information, such as name, address, and contact details.
3. Next, provide the necessary medical information, including the diagnosis, stage of cancer, and previous treatments received.
4. Indicate the required dose and number of TheraSphere vials.
5. Specify any additional accessories or equipment needed for the procedure.
6. Include any special requests or instructions for the delivery or administration of TheraSphere.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form, confirming its authenticity and agreement to the terms and conditions.
9. Submit the form to the appropriate TheraSphere ordering department either online or by mail/fax.
10. Keep a copy of the submitted form for records and reference purposes.

Who needs therasphere order form customer?

1. The TheraSphere order form is required by customers who are healthcare providers or institutions involved in the ordering and administration of TheraSphere.
2. This may include hospitals, clinics, radiology centers, nuclear medicine departments, or other medical facilities.
3. Healthcare professionals responsible for the treatment and management of patients with liver cancer or metastatic colorectal cancer may need to fill out the TheraSphere order form.

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What is therasphere order form customer?

Therasphere order form customer is a document used to request the purchase of Therasphere, a medical device used in interventional oncology.

Who is required to file therasphere order form customer?

Medical professionals and healthcare facilities who wish to order Therasphere for their patients are required to file the order form.

How to fill out therasphere order form customer?

To fill out the Therashpere order form, one must provide patient and facility information, as well as details on the requested quantity and shipping preference.

What is the purpose of therasphere order form customer?

The purpose of the Therasphere order form customer is to facilitate the purchasing process of Therasphere for medical treatment purposes.

What information must be reported on therasphere order form customer?

The order form must include patient name, facility details, quantity requested, shipping preference, and any additional instructions.