The Austen Bioskills Lab
47 N. Main St.
Akron, OH 44308
330-572-1662
bioskills@akronchildrens.org

Request a BioSkills Lab

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Your Information

Requestor
Requestor Job Title
Requestor Phone
Requestor Email
Referred By

Basic Information

Name of the Workshop/Lab/Course:
Date(s) Requested
Time Period Requested
Intended Audience
# of Attendees

Company Information, If Applicable

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Company Name
Street
City
State
Zip
Company Phone

Lab Instructions

Procedures
How many Stations are needed?
Are you bringing your own specimens?
# of Cadavers needed
Special Requests - Age:
Special Requests - Sex:
Special Requests - BMI:
Restrictive Health History (i.e. previous surgery,
Full Body- w/head
Full Body- no head
Torso to toe tip
Torso w/arms
Pelvis to toe tip
Pelvis to mid tibia
Mid femur to toe tip
Mid tibia to toe tip
Shoulder w/clavicle to finger tip
Mid-humerus to finger tip
Other

Equipment Instructions

C-Arm
MIS Surgery Tower
MIS Instruments
Arthroscopy Towers
Power Drills & Saws
Inlight Camera
Video Recording
How many instrument sets will you bring?
Special Notes

Other Needs

Conference Room
AV Equipment
What kind of media is used for the presentation?
Catering
Catering Details
Other Special Requests?
Any other information you would like to provide to