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Hartmann/Corstrata Referral Form
Hartmann Representative Name
*
Referral Contact Information
Name of Company
*
Contact First Name
Contact Last Name
Contact Email
*
Contact Phone Number
Number of Locations (if known)
Combined Average Daily Census (if known)
Business Model(s) (Check all that apply)
Home Health
Hospice
Skilled Nurse Facility
Wound Care Center
Other
Status of Hartmann Customer (Check all that apply)
Where are you in the sales process?
New Customer
Existing Customer
Initial meeting only
Trialing products
Revising formulary
Other
If an Existing Customer:
Which of the Hartmann products is the customer utilizing?
Have you trained the customer’s staff? If so, how many?
Are all of the customer's locations utilizing the same formulary?
What do you see as the customer’s need for Corstrata?
If you need to reach Corstrata, please
email
info@corstrata.com
or call (800) 566-1307.
Submit