UK – Summary Customer Dialog

Customer information

Salutation*

Name*

First Last

Practice/Organization*

Address

Street Address ZIP / Postal Code City Country

Phone

Email*

Status*

New customer

Existing customer

Existing devices

Our best solution for you

Device*

SPECTRALIS OCT

SPECTRALIS HRA+OCT

SPECTRALIS HRA

SPECTRALIS SPIRIT

HRT RCM

HEYEX 2

ANTERION

Modules

Comments

Email Focus*

SPECTRALIS

ANTERION

HEYEX 2

Event*

Sales Territory*

North

Southeast

Southwest

Initials of the Sender*

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Agreement*

I agree that Heidelberg Engineering GmbH may transfer this data solely for the purpose of responding to my contact inquiry to the distribution partner Heidelberg Engineering Ltd.. Heidelberg Engineering Ltd. is the fully owned subsidiary of Heidelberg Engineering GmbH in United Kingdom and processes data in compliance with local data protection laws and regulations. I confirm that I have read and accept the privacy statement. I understand that I can object to the use of my personal data with future effect at any time. I can address a revocation directly to the contact data stored in the privacy statement.