Welcome to SeaSpine’s COAST visit request portal. Our COAST program is designed to train and educate surgeons on our product offering while providing an introduction to our company, team and culture.
When completing the form below, please provide detailed responses to each question. Once submitted, the form will be routed for review and approval. The meeting objectives will be carefully examined during the approval process and therefore must be clearly defined.

Requestor Information

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Surgeon Information

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Has this surgeon ever attended a COAST visit? required

Date of Request

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Dietary Information

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Clinical Overview

Please identify the SeaSpine or competitive systems currently being used. Please be sure to include the percentage of practice for each procedure.

Systems being used:

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Percentage of practice:

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Office Assistant/Scheduler Information

Coast Visit Objectives

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Interests Per Franchise












Are systems approved in hospital? required

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(i.e posterior lumbar L2-S1)



(i.e. ALIF Access)

Travel Logistics

Flight required?


Hotel required?

Name(s) of Dinner Attendees

If you would like to include additional information, please use the comment box below:

Terms

To help protect our collaborative engagements, SeaSpine adheres to the standards set forth in the Medical Device Manufacturers Association Revised Code of Conduct on Interactions with Healthcare Providers (MDMA Code). SeaSpine will handle all travel and other expenses related to this event for healthcare providers in accordance with the MDMA Code. We are required to report the payment of expenses and other transfers of value in accordance with physician transparency reporting requirements.
Please note that forms submitted with incomplete fields will automatically be denied. If a request has been denied due to incomplete fields, you will be required to submit a new form.
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