Online Orders Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date *Purchase Order (if applicable)Certification Number or Therapist's Name *Your Ampcare Certified Speech Pathologist's name or Certification Number is appropriateCustomer / Facility Name *Department *Email for Order Confirmation *Accounts Payable Email *BillingFirst Name *Last Name *Address Line 1 *Address Line 2City *State / Province / Region *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPostal / Zip Code *Country *AfghanistanAlbaniaAlgeriaAmerican 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Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsShipping Address (Product Code Shipping *Use Billing AddressAdd Shipping AddressShip To *Address 1 *Address 2City *State / Province / Region *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPostal / Zip Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsContact Phone *Contact Email *ProductsESP Kit (Product 50706LT- Adult)Includes Powered Muscle Stimulator, 2 lead wires, Lead Wire Tester, 2 AA Batteries, 10 packages of Large E Series electrodes, Shoulder Strap Carrying bag and 1 Restorative Posture Device, 1 set of replacement pads, 2 Boxes of TENS Skin Prep wipes and 1 roll of non-adhesive wrap.ESP Kit (Product 50706ST- Youth)Includes Powered Muscle Stimulator, 2 lead wires, Lead Wire Tester, 2 AA Batteries, 10 packages of Small/Youth E Series electrodes, Shoulder Strap Carrying bag and 1 Restorative Posture Device, 1 set of replacement pads, 2 Boxes of TENS Skin Prep wipes and 1 roll of non-adhesive wrap.Ampcare ES Unit (Product 50710LT)Includes Powered Muscle Stimulator, 2 lead wires, Lead Wire Tester, 2 AA Batteries, 10 packages of Small/Youth E Series electrodes, Shoulder Strap Carrying bag and 1 Restorative Posture Device, 1 set of replacement pads, 2 Boxes of TENS Skin Prep wipes and 1 roll of non-adhesive wrap.Ampcare ES Unit (Product 50710ST)Hand-held, portable NMES unit, user manual, 10 packages of Small (Youth) E Series electrodes, 2 AA Batteries, 1 set of Lead Wires, Lead Wire tester, shoulder strap carrying bag.E Series Electrodes (Product 50709LT- Adult)Quantity / Packages0Quantity: 10 packages (4/pkg. 10 pkg/pouch) - 1 pouchQuantity: 20 packages (4/pkg. 10 pkg/pouch) - 2 pouchesQuantity: 30 packages (4/pkg. 10 pkg/pouch) - 3 pouchesQuantity: 40 packages (4/pkg. 10 pkg/pouch) - 4 pouchesQuantity: 50 packages (4/pkg. 10 pkg/pouch) - 5 pouchesQuantity: 100 packages (4/pkg. 10 pkg/pouch) - 10 pouches(4 Small electrodes per package; 10 packages per pouch)E Series Electrodes (Product 50709ST- Youth)Quantity / Packages0Quantity: 10 packages (4/pkg. 10 pkg/pouch) - 1 pouchQuantity: 20 packages (4/pkg. 10 pkg/pouch) - 2 pouchesQuantity: 30 packages (4/pkg. 10 pkg/pouch) - 3 pouchesQuantity: 40 packages (4/pkg. 10 pkg/pouch) - 4 pouchesQuantity: 50 packages (4/pkg. 10 pkg/pouch) - 5 pouchesQuantity: 100 packages (4/pkg. 10 pkg/pouch) - 10 pouches(4 Small electrodes per package; 10 packages per pouch)Lead Wire Tester (Product 50713)Ampcare Shoulder Strap Carrying Bag (Product 50714)Replacement Lead Wire Set with Lead Wire Tester (Product 50712)2 pair per set, Includes the Lead Wire TesterTENS Clean-cote skin preps (Product 50711)50 / boxSpecial Delivery InstructionsBy checking this box, you are agreeing to receive an invoice for the products ordered in this form *I agreeSubmit What people say about us "This course was fantastic! I learned so much and would highly recommend this to any of my colleagues. Thank you for making this presentation so digestible for the learner." -- Kevin Renz Ambrocio, M.S., CCC-SLP, - Austin, TX , , "I can honestly say this is the only course that I have ever attended where I did not want to leave the room because I would miss some great info. This course was fantastic and every slide/topic was incredibly pertinent. Never a dull moment, and the material is incredibly practical to my clinical practice. Thank you!" , “As a provider in today’s health care environment, effectiveness, quality, and value are first and foremost on our dashboard. The Ampcare protocol, device, and electrodes deliver consistent treatment allowing patients to return to their least restrictive consistency and texture.” -- Carmen Vitton, M.S., CCC-SLP, CDP, RAC-CT, - COO - Rehab Synergies , 2023 Overall Rating: 4.97 out of 5 stars
