Request an Event or Samples

Please be advised that all orders and event requests require approval before making any commitments. While submission of this form is necessary, it does not automatically signify approval for the respective event. We will reach out to inform you of the status of your event once it has been reviewed and approved.

All orders are fulfilled in the order that they were received and are subject to availability. Please note that any orders submitted within 2 weeks of the event may not be fulfilled. All sample requests are subject to the availability of product.

Return samples within 48 hours of the end of the event using the return labels provided.

Click the different event options below to learn more about what that type of event entails, then fill out the form at the bottom of this page.

Local Sawbone Lab

When approved, we will work with the region to coordinate a local lab between the Health Care Provider (HCP) and regional team. If a HCP proctor is needed for this lab please provide details and ensure approval is confirmed. Please ensure all known distributor labs are also being requested for tracking purposes.

Local Lab Details:

Request minimum two (2) weeks in advance
Request minimum four (4) weeks in advance if HCP consultant proctor required
Executed by the local Anika Commercial Team and additional Anika employees as needed
Average Lab Time = 3 hours
Hands-on product demonstration with experienced Anika representatives
One (1) commercial rep per surgeon attendee
Distributor travel and accommodations are funded by the distributor

Innovation Dinner Symposium Request

When approved, we will work with the region to coordinate an Innovation Symposium between the Health Care Provider and an Anika educational consultant. We will organize the surgeon speaker and work closely with the region to tailor event details to meet the attendee learners’ needs.

Innovation Symposium Details:

Request a minimum of four (4) weeks in advance
Executed by the local Anika Commercial Team and additional Anika employees as needed
Subject to regional and national KOLs availability
Commercial is responsible for organizing dinner venue within Anika policy and AdvaMed guidelines
Half Day (1/2) Event – Evening, Journal Clubs, or Grand Rounds
Average Time = 3 hrs
Anika Faculty Consultants Discuss Products, Procedures, Recent Evidence and Patient Cases
Sawbones demonstrations encouraged with implants and instrumentation
One (1) commercial rep per surgeon attendee
Distributor travel and accommodations are funded by the distributor
HCP Dinner limit is $185 inclusive of tax, tip and fees. Submission of receipt through Concur following event required with HCP information
Name and signatures of all HCPs attending event must be documented

Surgeon to Surgeon (S2S) Discussion Request

Info:

When approved, we will coordinate a video chat on MS TEAMS or phone discussion between the Health Care Provider (HCP) and an Anika educational consultant.

Surgeon to Surgeon (S2S) Details:

Requested minimum 1 week out
Sharing of Knowledge, Evidence and Clinical Practice
Include required details to assist with setting up the discussion
Anika will connect the HCP to an educational consultant via MS TEAMS / Audio
Executed as soon as possible (depending on the day of request and faculty availability)

"*" indicates required fields

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URL

This field is for validation purposes and should be left unchanged.

Please choose the option that best describes your role.*

Anika Sales

Anika Marketing

Distributor (Based in the United States)

Non-U.S. Based Anika Employee/Distributor

I am a/an…*

International Anika Employee

International Anika Distributor

Distributor/Company Name

Region*

International Director Name*

Name of Requestor*

First Last

What is the name of the distributorship tied to this event?*

Email*

Cell Phone Number*

Event Type*

Sawbones Demonstration

Conference

Surgeon to Surgeon Discussion

Innovation Symposium (Dinner Program)

Integrity Replenishment Samples Only

Integrity Replenishment Samples

6000101 – 25x30mm Integrity Implant

6000102 – Integrity Implant Fixation Caddy

6000118 – Bone Staple Delivery Instrument

6000120 – Tissue Tack Delivery Instrument

Integrity Sawbones

Quantity of 6000101 – 25x30mm Integrity Implant

Quantity of 6000102 – Integrity Implant Fixation Caddy

Quantity of 6000118 – Bone Staple Delivery Instrument

Quantity of 6000120 – Tissue Tack Delivery Instrument

Quantity of Integrity Sawbones

Event Date*

ALL REQUESTS MUST BE SUBMITTED a minimum of 2 WEEKS IN ADVANCE of the event. If a HCP proctor is required, form must be submitted at least 4 weeks in advance of event date.

MM slash DD slash YYYY

Please enter the name of the conference below:*

Please specify the type of event:*

Internal Anika sales training distributor

Distributor training themselves

Surgeon training event

Other

What is the primary product for this event?*

Integrity

Tactoset

Other

Please specify how many surgeons (HCP attendees) are anticipated to attend.*

List the full name(s) of the HCP attendee(s) for this event.*

Email of HCP Attendee*

Phone Number of HCP Attendee*

What is the learning objective of the HCP attendee(s)?

This should be a short 1 sentence answer.

Will a surgeon proctor be required for this event?*

Please note events with surgeon proctors must be scheduled at least 4 weeks in advance of event.

Yes

Maybe

What Anika educational faculty will meet the learners needs for this event?*

Does the attendee prefer video or phone call for this discussion?

Video Call

Phone Call

Other

Does this event require Anika instrumentation/samples?*

Yes

Will there be a facility fee or room rental fee for this event?*

Yes

I’m not sure

What is the estimated facility fee?

On-Site Contact Name (First & Last)*

***On-Site contact MUST be physically present (and answer their cell phone) for the entire 3-hour drop off and pickup window. If this person is not present, delivery may be delayed or cancelled and we will be charged a fee.

First Last

On-Site contact cell phone number*

This must be their cell phone and not their general office phone number. They will be contacted if any issues arise.

Will you (the requestor) be present at this event?*

Yes

Please provide the name of the Anika Sales or Distributor representative that will be present at this event.*

This person will be responsible for everything that occurs during the event from an Anika perspective.

First Last

Cell phone number for Anika Sales or Distributor Representative that will be present at the event.*

Event Facility Name*

Event Facility Address*

Please ensure this address is accurate and complete.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Regenerative

Regenerative Samples

Integrity: Blue Demo Bag (Includes Instruments & Implants)

Integrity: Dome & Sawbones

Tactoset: 11Ga Delivery Cannula Set 1000040

Tactoset: 15Ga Delivery Cannula Set 4000050

Tactoset: Material Set: 6000041

Marrow Cellution: SAMPLE Standard 6000150

Please note: A heat source is recommended when demonstrating anchor augmentation using Tactoset.

Quantity of Integrity Blue Demo Bag(s)

Includes 1 25x30mm Integrity Implant; 1 Integrity Implant Fixation Caddy; 1 Bone Staple Delivery Instrument; 1 Tissue Tack Delivery Instrument

Quantity of Integrity Dome & Sawbones

Includes 1 Integrity Dome & 3 Sawbones

Quantity of 11Ga Delivery Cannula Set: 1000040

includes 1 drillable outer cannula with removable drillable stylet; 1 inner cannula for end delivery; 1 inner cannula for side delivery; 1 push rod

Quantity of 15Ga Delivery Cannula Set: 4000050

includes 1 drillable outer cannula with removable drillable stylet; 1 push rod

Quantity of Tactoset Material Set: 6000041

includes: 1 prefilled mixing syringe containing Tacoset powder; 1 glass syringe containing Tactoset setting solution; 4 Luer lock syringes (1 mL); 1 female-female Luer lock connector

Quantity of SAMPLE: Marrow Cellution Standard: 6000150

Replenishment Samples

Integrity Blue Demo Bag Replenishment Samples

6000101 – 25x30mm Integrity Implant

6000102 – Integrity Implant Fixation Caddy

6000118 – Bone Staple Delivery Instrument

6000120 – Tissue Tack Delivery Instrument

Integrity Sawbones

Quantity of 25x30mm Integrity Implant: 6000101

Quantity of Integrity Implant Fixation Caddy: 6000102

Quantity of Bone Staple Delivery Instrument: 6000118

Quantity of Tissue Tack Delivery Instrument: 6000120

Quantity of Integrity Sawbones

Sawbones Drills & Clamps

What other marketing materials do you need? Please check all that apply.

Sawbones Drill(s)

Sawbones Clamp(s)

Number of Sawbones Drills

Number of Sawbones Clamps

Anika Marketing Only

This page is only to be filled out by Anika Marketing employees for Conferences, Medical Education Events, Sales Education Events, etc.
Literature should be ordered through the Literature Request form.
Banners/tablecloths must be ordered through the banner form (fulfilled by Signature Printing).

Miscellaneous Marketing Items

Lanyards

Name Tag Holders

Podium Banner

Tactoset Stand

Clamps & Sawbone Drills

Easel Stands

Literature Rack

# of Lanyards

# of Plastic Name Tag Holders

# of Tactoset Stand Sets

# of Clamps & Drills

# of Easel Stands

Anything else?

Shipping for Anika Samples/Equipment

Date for items to be delivered*

MM slash DD slash YYYY

Attention to:*

First Last

Company/Name

Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please include any special shipping instructions below:

By submitting this form I acknowledge and confirm that this event will follow all Anika and AdvaMed compliance guidelines.*

I agree