Order and Quotation Form

ORTA™ Vascular Model Series Order and Quotation Form

Quotation Process

  • STEP 1

    Select "Order Request" in the "Details of Request" section of the form and fill in the required information.

  • STEP 2

    After submitting the form, you will receive a confirmation email.

  • STEP 3

    We will send you a quotation to the e-mail address you entered in the form within a week.

Ordering Process

  • STEP 1

    Select "Order Request" in the "Details of Request" section of the form and fill in the required information.

  • STEP 2

    After submitting the form, you will receive a confirmation email.

  • STEP 3

    We will send you a quotation and invoice to the e-mail address you entered in the form within one week.

  • STEP 4

    Please check the contents of the quotation, and if you are satisfied with the quotation, please make a bank transfer to the bank account indicated on the invoice.

  • STEP 5

    We will arrange for the manufacturing of the product and inform you of the delivery date.

  • STEP 6

    After receiving the product, please inspect the product and check its operation.

Fill out your order/quote

Please fill out the following form and select the "Confirm" button.
All fields are required except for a few.

Details of your request

ORTA™ Vascular Model Series

Shape Patterns of
PVA Hydrogel Vascular Model

Please select your desired shape pattern (multiple selections possible)
Select a shape pattern to display the image.

Actual cerebral blood vessel model - small size

Actual cerebral blood vessel shape - Normal size

Cardiovascular Shape

Aortic Shape

Shape Model for Medical Device Evaluation

Equipped with sensor gauge

Name of company/organization

Name of person in charge

E-mail address

Re-enter for confirmation

Phone number (*no hyphen)

Postal code (*no hyphen)

Your Address

State/Province
City/Town/Village
Address below
Building name etc.

Blue Practice complies with the "Act on the Protection of Personal Information" and other regulations, and manages and operates the personal information provided to us with the utmost care regarding its storage and use.


Personal Information Management

In order to keep the provided personal information accurate and up-to-date and to prevent unauthorized access, loss, damage, falsification, leakage, etc. of personal information, we appoint a person responsible for the management of personal information and take necessary measures such as maintaining a security system, improving the management system, and thoroughly educating employees to implement safety measures and strictly manage personal information.We will strictly manage personal information.


Use of Personal Information

Personal information provided to us will only be used within the scope of the purpose for which it was obtained with your consent, and will not be used for any other purpose.


Prohibition of disclosure or provision of personal information to third parties

We will not provide personal information to third parties without the prior consent of the individual, except in cases outside the scope of restrictions on the provision of personal information to third parties as stipulated in Article 23.1 of the "Act on the Protection of Personal Information" and in the cases listed below.
Providing personal information to subcontractors whose security regarding the protection of personal information has been confirmed.


Security measures for personal information

We take all possible security measures to ensure the accuracy and safety of personal information.


Confirmation and Correction of Personal Information

If you request confirmation or correction of your personal information, we will respond to your request appropriately and promptly within reasonable limits.


Compliance with and review of laws, regulations and norms

We will comply with Japanese laws, regulations, and other norms applicable to personal information in our possession, and will review and improve the contents of this policy as appropriate.

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