Forms · Generator exchange

Surgical registration form

Use this form to register surgical interventions related to VNS Therapy, such as a generator replacement.

Name of hospital

City

Treating clinic Department or clinic responsible for the patient's VNS follow-up.

Old serial number

New serial number

Reason For example: end of service, lead revision, elective replacement. No patient-identifying information, please.

Your name

Your email We send the confirmation here.

Do not include patient names, personal identity numbers or other patient-identifying information in this form. Serial numbers and clinic details are sufficient.

Or email the same details to info@gonorthmedical.com.