Clinical Trials Support Portal

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Equipment Order Form

Please complete the form below to request additional equipment for your study. Please be aware that all requests require sponsor approval and may take up to 5 business days for processing and delivery. To request service or to return a device, click here.

Choose your product family

Actiwatch Spectrum Pro

GENEActiv

Actiwatch 2

Equipment Order Form

* This field is mandatory

Equipment

Actiwatch Spectrum Pro Device

Micro USB Cable

Study Guide

Study Software USB Drive

Supplemental Packet

Power Supply (for USB charging)

Power Supply Adapter Set (for international power connections)

Actiwatch Connect Flash Drive

Study details

Country

Study protocol*

Site number*

First name*

Last name*

Email address*

Phone number*

What is cross border data transfer?

I agree on cross-border transfer of personal information.

Information submitted on this form will be processed by Philips Respironics in the United States. Please read our Privacy Notice.

Equipment Order Form

* This field is mandatory

Equipment

GENEActiv Device

GENEActiv Cradle w/USB Cable

GENEActiv Software USB Drive

Study Guide

Supplemental Packet

Study details

Country

Study protocol*

Site number*

First name*

Last name*

Email address*

Phone number*

What is cross border data transfer?

I agree on cross-border transfer of personal information.

Information submitted on this form will be processed by Philips Respironics in the United States. Please read our Privacy Notice.

Equipment Order Form

* This field is mandatory

Equipment

Actiwatch 2 Device

Actiwatch 2 Communications Dock w/USB Cable

Actiwatch 2 Hospital Bands (Pkg. of 25)

Study Software USB Drive

Study Guide

Actiwatch Connect Flash Drive

Supplemental Packet

Study details

Country

Study protocol*

Site number*

First name*

Last name*

Email address*

Phone number*

What is cross border data transfer?

I agree on cross-border transfer of personal information.

Information submitted on this form will be processed by Philips Respironics in the United States. Please read our Privacy Notice.

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