Your Name (required):
Your Email (required):
Your Telephone Number (required)
Your Clinic Name (required)
Your Ocean Site Number (Please enter 0 if no site number available)
I am interested in ordering the following:
Floor Stand Kiosk ($550 + Shipping)
Countertop Kiosk ($310 + Shipping)
To ensure the Check-In Kiosk solution meets the needs of your clinic, please confirm one of the following:
Yes, I have seen a demo of the Check-In Kiosks.No, I have not seen a demo of the Check-In Kiosks. Please contact me to set one up.
If you selected yes, please confirm who lead the demo:
Ocean by CognisantMDEMR Sales RepresentativeOther
Please note, only the Samsung Galaxy Tab E 9.6" Tablet is supported for check-in kiosks. Please confirm you have purchased the appropriate tablet model.
Yes, I have/will purchase a Samsung Galaxy Tab E 9.6 to use with the kiosk hardware
For Clinics in Ontario, British Columbia and Nova Scotia only:
In order to support self-check-in with a built-in magnetic card reader, the Check-In Kiosk requires a peripheral package and supported tablet model. The peripheral package includes:
Yes, I require peripherals (You will be invoiced for each bundle)
Please provide your shipping contact name and address
*Please note that Kiosk stands do not ship until payment is received.
*Please note that Kiosk stands may only be returned or exchanged within 30 days of purchased, undamaged and in the original box. Kiosk returns are subject to a restocking fee of $150.00.