Patient Marketing Authorization Form
"*" indicates required fields
"*" indicates required fields
You just clicked on a link to go to another Mainstay Medical ("Mainstay") website that is different from your current website, which is specifically intended for your country/region. Please note there may be important differences on Mainstay websites designed for other countries/regions, including information about product (ReActiv8) indication and use, regulatory approval, healthcare practice standards, and data protection laws, among other things. Do you still wish to continue to the different site?