This form is for new equipment requests (not replacements).  

When requesting for new equipment such as ECG machines, ABPM and holter monitors, this form needs to be signed and approved by collectors manager and sent to cardioscan for cardioscan management approval.  

When requesting consumables such as BP cuffs, SD (for CSC-6612 holters), Flash cards (for DMS 300-7 Holters), straps, ECG leads  - Complete this form and email to helpdesk@cardioscan.com.au  or fax to 0398322292 

**Job number will be allocated once form has been received by cardisocan.