Conceptus Information Form

PatientBuilder provides marketing materials to promote Essure and your practice, including ads, postcards, and appointment cards. PatientBuilder also provides targeted mail lists, media analysis research, and media placement services.

If you have any questions about the form, contact Susie Barr at 417-447-5050 or email sbarr@patientbuilder.com. Your Conceptus representative will assist in approval for a personalized PatientBuilder.com account.

If you have difficulty submitting, you may complete this Word version and fax to 417.887.2935 or email to sbarr@patientbuilder.com.

Please read the user agreement before filling out the form below.

 

©2006 | PatientBuilder.com is a subsidiary of Medical Consulting Group LLC.