Live Laser or Device Demonstration

If your company is supporting a live laser or device demonstration, complete the form below by November 15, 2017.

Application/Procedure*
Type of Device*
Electrical Requirements*
Ex. 230 VAC/30 A
System Cooling
Requested Demonstrator(s)*
Does this device require a warm-up period before use?*
- Yes
- No
Does this device require pipe and drape or goggles?*
- Yes
- No
Will you be submitting any research for the ODAC Poster Session?*
- Yes
- No
General supplies needed for live demo - Gloves:
- We will supply gloves
- Please supply latex
- Please supply non-latex
If we need to supply gloves, indicate the size below
General supplies needed for live demo - Goggles:
- We will provide goggles for this session
- Goggles are not needed for this session
General supplies needed for live demo - Gel:
- We will provide gel
- Gel is not needed for this procedure
This demonstration should be performed behind a curtain:*
- Yes
- No
Please specify all other general supplies needed for demonstration of this type
Number of patients needed:*
Do you have a preference for patient type? This will also be confirmed with the demonstrator. Describe criteria/characteristics.
Would you like to bring your own patient?*
- Yes
- No
If you will be bringing your own patient, provide their information below.
Name Phone Number Email
Company Contact or Medical Assistant Name
Name Phone Number Email

Nurses CE
Creighton University Health Sciences Continuing Education designates this activity for 30.25 contact hour(s) for nurses. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by Creighton University Health Sciences Continuing Education (HSCE) and the Physicians Continuing Education Corporation. Creighton University Health Sciences Continuing Education (HSCE) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Live Laser or Device Demonstration

Additional Info