Badge request form

If you’re a SurgiCount System user, we’re happy to provide complimentary data-matrix badges. For badge replacements, new staff members and additional badge requests, please enter your information below. All requests submitted by Monday before 7am PST will be delivered to your hospital 10 to 14 business days for most U.S. locations. Please allow one or two additional days during the holidays.

Badge request form

Please fill out all required (*) fields and verify all entries for spelling accuracy:

Requester Information

Shipping Information

(39 characters max)

List all badges here (at least one): *

Last NameFirst NameDepartment (O.R., O.B., etc.)

New implementations

Click here for a downloadable template and send via email to at least two weeks prior to your go-live date.

Additional questions

Please email

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