Page 2 - Medical Surgical Pod

My Sim Lab ™

Lab Creation Questionaire
EASILY

Please take a moment to fill out this form so that we may better CONVERT

service your lab creation needs. CLASSROOMS

When you submit this form for a quote, it will be emailed to TO LABS

Amy Hallstein, Senior Account Manager.
When space is at a premium at your facility,
Should you need to provide additional information please email this furniture provides a solution. Easy to move,

Amy at ahallstein@pocketnurse.com. stack, and store, it allows you to open a Nesting Chairs
classroom up for simulation drills. These chairs
and tables help you convert the space to a 04-50-3041 2/Case
Black Only
hospital room or clinic for your students. Quantity

Contact Name:

Department:

School Name:

School Address:

Phone: Ext. E-mail:

Program Type: RN ADN LPN CNA MA

(Check all that apply)
NP/PA Pharmacy Other:
Training Chair with Valore Mid-Back Chair
No Arms with Arms
04-50-3043 2/Case 04-50-3042 2/Case
Black Only Black Only
Quantity Quantity

Building Type: New Construction Renovation

Your Lab Status: Applying for Grant Construction of Facility New Program Flip-N-Go Table
Sold Individually
Equipping Lab from Scratch Upgrading Lab Equipment Black Only
SKU# ITEM QUANTITY
Estimated Date of Project Completion: 04-50-3044 72” x 18” Rectangular

Are you working with? Architect In-House Project Manager Other 04-50-3045 60” x 18” Rectangular

(Check all that apply)