Medtronic Surgeon Locator Registration

Please complete the form below to be added to the Medtronic Hernia Surgeon Locator.

Section 1

Who is completing this form?

Section 1 information will not be visible on the Hernia Surgeon Locator results.

First Name*

Last Name*

Email*

Company

Section 2

Please complete the fields below.

Section 2 information will be visible on the Hernia Surgeon Locator.

About the practice:

Practice Name*

Website*

Street Address

City

State/Territory

Postcode

Country

Phone Number

Hospitals/Practice:

List of Hospitals/Practices where you operate

Hospital/Practice 1

Hospital/Practice 1 Website

Hospital/Practice 2

Hospital/Practice 2 Website

Hospital/Practice 3

Hospital/Practice 3 Website

If you operate in more than 3 hospitals, please include below:

Surgeon Information:

Salutation*

First Name*

Last Name*

Your Email*

Job Role*

I agree to receive updates about the Hernia Surgeon Locator*

By submitting this form, you acknowledge that Medtronic will collect your information for the purpose of adding you to our healthcare professional database. Your information will be used and or disclosed in accordance with our Privacy Policy.

How did you find out about this website/surgeon finder?

Medtronic Rep Name:

Your information is being collected by Medtronic Australasia Pty Ltd and/or Medtronic New Zealand Limited and dealt with in accordance with our Privacy Policy which can be found at www.medtronic.com.au. We may share your information with our employees, third-party suppliers and agents working on our behalf, including overseas companies within the Medtronic Group most likely Singapore, Netherlands, Philippines and the United States. We take all reasonable steps to ensure that any recipient is bound by similar privacy protections to those in ANZ. While Medtronic cannot guarantee against any loss, misuse or alteration to data, we take reasonable steps to prevent such occurrences. You may request access to, and correction of, your personal information by sending and email to rs.datasubjectrightrequest@medtronic.com, or complain about a breach of your privacy by sending an e-mail to privacy@medtronic.com.

*Medtronic provides this listing as a service. We have no vested interest in any specific physicians, nor do we provide any recommendation, assurance, or guarantee with respect to their service. This listing may not be a complete list of all physicians who provide this service.