[B2B] MPK Trial Form

Request a MPK Trial

If you are a prosthetist interested in trialing a microprocessor-controlled knee, please fill out the form below. Your local Ottobock representative will reach out to you directly.

Contact Information

First Name*

Last Name*

Email*

Phone*

Please select the product you are interesting in trying*

Clinic Information

Clinic Name*

Address*

City*

Zip Code*

Country*

State*

Province*

Comments

I would like to get more information about events, products, and services from Ottobock and confirm that the above information is correct.

By filling out this survey you hereby agree to allow Ottobock to save and use the personal data and medical data, if applicable, that you have provided in the survey form for the purpose of processing/responding to my inquiry. View Ottobock Data Privacy here.*

I have read and understand the Terms and Conditions.*