Sample Order Form

ProLong - Non-Stimulating 21G continuous block catheter set
Teflon Coating, Tuohy Borst Adaptor, 0.2 mm Needle Tip Exposure
		Block Bevel, 19G Needle
	PL-40C	40mm (1.5") Useable Needle Length
	PL-50C	50mm (2") Useable Needle Length
	PL-100C	100mm (4") Useable Needle Length
	PL-150C	150mm (6") Useable Needle Length
		Tuohy Bevel, 18G Needle
	PLT-40C	40mm (1.5") Useable Needle Length
	PLT-50C	50mm (2") Useable Needle Length
	PLT-100C	100mm (4") Useable Needle Length
	PLT-150C	150mm (6") Useable Needle Length

ProLong Micro - Non-Stimulating 24G continuous block catheter set
Teflon Coating, Tuohy Borst Adaptor, 1 mm Needle Tip Exposure
		Chiba Bevel, 20G Needle
	PLM-25	25mm (1") Useable Needle Length
	PLM-50	50mm (2") Useable Needle Length
	PLM-100	100mm (4") Useable Needle Length

ProBloc - Single Injection PNB Needle Sample Selection
Sleeve Insulation, Needle Only
		Block Bevel, 22G Needle
	HN1-40	30mm (1.2") Useable Needle Length
	HN1-80	70mm (2.75") Useable Needle Length
	HN1-100	90mm (3.5") Useable Needle Length
Sleeve Insulation, Injection Set
		Block Bevel, 22G Needle
	HN2-40	30mm (1.2") Useable Needle Length
	HN2-80	70mm (2.75") Useable Needle Length
	HN2-100	90mm (3.5") Useable Needle Length
Sleeve Insulation, Injection Set and Stimulating Wire
		Block Bevel, 22G or 20G Needle
	HN3S-25	22G Needle, 15mm (.6") Useable Needle Length
	HN3S-40	22G Needle, 30mm (1.2") Useable Needle Length
	HN3S-80	22G Needle, 70mm (2.75") Useable Needle Length
	HN3S-100	22G Needle, 90mm (3.5") Useable Needle Length
	HN3S-120	20G Needle, 110mm (4.7") Useable Needle Length
	HN3S-150	20G Needle, 140mm (5.5") Useable Needle Length

ProBloc SC
Sleeve Insulation, Needle Only
		Block Bevel, 25G Needle
	HN1-SC	30mm (1.2") Useable Needle Length
Sleeve Insulation, Injection Set and Stimulating Wire
		Block Bevel, 25G Needle
	HN3S-SC	30mm (1.2") Useable Needle Length
Teflon Coating, Injection Set and Stimulating Wire
		Block Bevel, 25G Needle
	HN3SC-25C	25mm (1") Useable Needle Length
	HN3SC-40C	40mm (1.5") Useable Needle Length
Teflon Coating, Injection Set and Stimulating Wire
		Chiba Bevel, 25G Needle
	PB-25SCS	25mm (1") Useable Needle Length
	PB-40SCS	50mm (2") Useable Needle Length

ProBloc II - 25G Single Injection Needle
Teflon Coating, Injection Set and Stimulating Wire
		Block Bevel, 22G or 20G Needle
	HN3S-50C	22G Needle, 50mm (2") Useable Needle Length
	HN3S-80C	22G Needle, 80mm (3") Useable Needle Length
	HN3S-100C	20G Needle, 100mm (4") Useable Needle Length
	HN3S-120C	20G Needle, 120mm (4.7") Useable Needle Length
	HN3S-150C	20G Needle, 150mm (6") Useable Needle Length
Teflon Coating, Injection Set and Stimulating Wire
		Chiba Bevel, 22G or 20G Needle
	PB-25CS	22G Needle, 25mm (1") Useable Needle Length
	PB-50CS	22G Needle, 50mm (2") Useable Needle Length
	PB-100CS	20G Needle, 100mm (4") Useable Needle Length
	PB-150CS	20G Needle, 150mm (6") Useable Needle Length

For ContiStim® samples, please contact your local U.S. or International representative

Delivery Address and Contact Information
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NOTE: Indicate the brand and model of stimulator to be used in order to receive the appropriate interface lead set or adaptor.