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We're thrilled that you're interested in joining our Get Lit 2024 Pilot Program! To get started, please take a moment to complete the form below by April 15th This will provide us with the information required to enroll you in this program. If you have any questions please contact me at [email protected].

First Name

Last Name

Physician(s) Name Requesting Trial *

Business Email *

Phone *

Job Title *

Shipping Street Address *

City *

State *

Country *

Country

Postal code *

Credentialing System

Surgical Speciality (one or more) *

Requirements for training SPD and In-Service

What days and times do you dedicate weekly or monthly for training staff and surgeons?

Requested trial month

Can you provide a zero dollar PO?

How did you hear about us?

Please provide any information regarding your purchasing process (timeline to obtain a PO, buying cycle, operational vs capital budget, who approves purchase)

Please submit any documents that require completion by MezLight.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

If there are additional people that need to be contacted, please include their name, email, and job title below.

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[email protected]

525 Junction Road

Suite 6500

Madison, WI 53717

p 877.404.2248

f 608.960.4610

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