Form to become a client of Mediq OÜ  

In order to become a contractual client, which allows you to place orders via phone sales and e-mail, please fill out the form below.
Fill in the fields and press the SEND button. Your application will be reviewed and, if everything complies with the requirements, you will be registered as a client.
If you also want to access Mediq OÜ's business client order portal, fill in the relevant field on the form and our Sales Department will contact you.

Form for becoming a client

Provide your information and make sure the information is correct.
Fields marked with an asterisk are required.