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 Hospital or Facility /Department

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.

Use of Personal Information for ORDER of Vascular model, ORTA™

Blue Practice collects and uses personal information from individuals in charge of ordering or requesting quotations for the Vascular Model Series ORTA™. This information is used for handling orders and quotations, issuing invoices when commissioned, and shipping products.


Collected Personal Information

The following personal information is required to process orders and quotation requests:
• Request Information: Order request, quotation request, vascular model shape pattern, sensor terminal presence
• Customer Information: Company/hospital name and department, name, furigana, email address, phone number, postal code, prefecture, city, street address, building name, etc.


Purpose of Use of Personal Information

The request and customer information will be used for the following purposes:
• To confirm request details (via phone, email)
• To send quotations and invoices (via phone, email, or mail)
• To communicate regarding manufacturing (via phone, email)
• To deliver products and delivery slips
• For representative/sales management and billing processing
• For after-sales support
• To provide information on services
• To improve products and services


Outsourcing of Personal Information Handling

This form’s website uses data centers, and Japan Post and Yamato Transport for product shipment. Part of the manufacturing process may be outsourced.


Provision of Personal Information to Third Parties

Personal information provided in connection with orders, quotations, or commissioned manufacturing will not be shared with third parties.


Correction and Suspension of Use of Personal Information

To confirm, correct, or suspend the use of registered information after submitting an order or quotation, please contact your sales representative or the Personal Information Inquiry Desk.


Complaints and Consultations Regarding Personal Information

For complaints or consultations regarding the handling of personal information related to orders, quotations, or commissioned manufacturing, please contact the Personal Information Inquiry Desk using the contact form.


Blue Practice Inc.
Plaseo Aoyama Building 3F, 2-7-13 Kita-Aoyama, Minato-ku, Tokyo
Personal Information Protection Officer
Contact Form

  • Blue Practice

copyright© Blue Practice all right reserved.