Cadwell Donations Request Form

As part of our CadCare™ commitment, we partner with healthcare providers and educational programs to reduce financial and clinical barriers to care. We achieve this by donating equipment and providing funding for educational grants, helping patients worldwide gain access to life-changing technologies.

Young boy having EEG electrodes placed on his head.

Technologist smiling at camera and holding EEG electrodes.

Technologist smiling and holding EEG electrodes.

Cadwell Donations

Please read our Cadwell Donations Policy, prior to using this form.(Required)

Cadwell Donations Policy

I have read the Cadwell Donations Policy

Will these systems/electrodes be used for charitable purposes only?(Required)

Yes

Is your program a 501(c)(3)?(Required)

Yes

Provide proof of your organization's charitable/nonprofit registration here:(Required)

(e.g., IRS 501(c)(3) determination letter in the U.S., or equivalent documentation)

Max. file size: 50 MB.

Are you requesting a permanent donation or temporary loaner?(Required)

Permanent donation

Temporary loaner

Name of Program:(Required)

Number of Systems/Electrodes Requesting:(Required)

Please enter a number greater than or equal to 1.

Type of Systems/Electrodes Requesting:(Required)

EEG Systems

EMG/Ultrasound Systems

IONM Systems

PSG/HSAT Systems

Electrodes

Requestor Information

Name(Required)

First Last

Address(Required)

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

Phone(Required)

Include Country Code if outside U.S.

Email Address(Required)

NPI Number

(If covered recipient)

Location of Use of Organization or Medical Facility

Location of Use(Required)

Please indicate the facility/organization in which this donation will be used

Contact Name(Required)

First Last

Address(Required)

Same as Requestor Address

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

Phone

Include Country Code if outside U.S.

Email Address

Organization's Website

Start with "https://"

Donation Request Notes

Add any additional information or notes here, regarding this donation request.

Additional File Uploads

Use this to upload any additional documents or files related to this donation request, if needed.

Max. file size: 50 MB.

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