Badge request form

If you’re a SurgiCount System user, we’re happy to provide complimentary data-matrix badges. For badge replacements, new staff members and additional badge requests, please enter your information below. All requests submitted by Monday before 7am PST will be delivered to your hospital within 10-14 business days for most U.S. locations. Please allow one or two additional days during the holidays.

Badge request form old

Please fill out all required (*) and verify all entries for spelling accuracy:

New implementations

Click here for a downloadable
template and send via email to
at least two weeks prior to your go-live date.

Additional questions

Please email

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