ORDER FORM

Use this order form to request the sizing guide of your choice.
Available for fit testers only.
Sizing guides will be available shortly.
Pre-orders are accepted at this time.

Already have a sizing guide?

Use this form to reorder individual items to replenish your kit.

Who can place orders?

If you have purchased one of our respirators, we invite you to pre-order a sizing guide or any individual items you need to replenish.

1Your Details

2Support Items

3Order Summary

Name*
First Last
Email*
Enter Email Confirm Email
Job Title*
Hospital*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Quantity required of each item
Medicom Fit Test Kits
Coordinator Pack
Created specifically for fit test coordinators or Architect Pro leads in hospitals or healthcare facilities, it contains all the information that the user needs. Many of the items are printed on a wipe-clean material to allow repeated use.
Co-ordinator Pack QTY
Please enter a number from 0 to 1.
Fit Tester Kit
These convenient kits contain everything needed to perform fit tests. As with the coordinator kit, many items are printed on easy-clean material for repeated use.
Fit Test Pack QTY
Please enter a number from 0 to 1.

Name:

{Name (First):2.3} {Name (Last):2.6}

Email:

{Email:4}

Job Title:

{Job Title:1}

NHS Trust:

{NHS Trust:3}

Address:

{Address (Street Address):26.1}

{Address (Address Line 2):26.2}

{Address (City):26.3}

{Address (State / Province):26.4}

{Address (ZIP / Postal Code):26.5}

{Address (Country):26.6}
Co-ordinator Pack

Pack quantity: {Co-ordinator Pack Qty: :47}

Fit Test Pack

Pack quantity: {Fit Test Pack Qty: :22}
Confirmation/Agreement*
- I confirm I have read and agree to the Terms and Conditions.
The personal information you have supplied will be used by Medicom to process your request. Your details may be used to contact you about further Medicom developments. Your data will be processed according to Medicom Privacy Policy. You have the right to access, modify and delete your personal information from our records. To do so, you can write to the following address: AMD Medicom Inc., 2555 Chemin de l’Aviation, Montreal, Quebec, Canada H9P 2Z2 or email us at medical@medicom.ca. Your personal information will not be used for any other purposes.
Are you human?
Order ID
Phone
This field is for validation purposes and should be left unchanged.

MEDICOM Sizing Guide for coordinators

Created specifically for Fit Test Co-ordinators or Architect Pro leads in hospitals or healthcare, it gives all the information that the user needs. Many of the items are printed on a wipe-clean, easy to use material to ensure they can be used time and again.

View Contents

Medicom Sizing Guide for Fit testers

Dedicated to Fit Testers, these handy-sized A4 kits are perfect for use when carrying out Fit Tests. As with the Co-ordinator pack many items are printed on an easy-clean material for use time and time again.

View Contents