Battery

Acknowledgement Form

This webform is to verify that you have read and understood the Notification to Customers about the risks of improper battery insertion into the LeadCare Analyzer. This is being tracked for regulatory purposes.

Please complete this form and submit:

Battery Acknowledgement

We have read, understood and reviewed the Notification with our staff, and affixed the caution label(s) provided.

YES

NO, we do not own or operate a LeadCare Analyzer

Organization Name

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Instrument Serial Number

First Name
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Last Name
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Email
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