AI WELLNESS × WEBER MEDICAL

Order Form

Thank you for your interest in Weber Medical technologies.

Please complete this form to request pricing, financing, leasing, or purchase of Weber Medical devices through AI Wellness. An AI Wellness representative will review your request and contact you to discuss product selection, financing options, training, shipping, and installation.

Weber Order Form

CUSTOMER INFORMATION

Name
Name
First Name
Last Name
Billing Address
Billing Address
City
State/Province
Zip/Postal
Country
Is the shipping address same as the billing address?
Shipping Address
Shipping Address
City
State/Province
Zip/Postal
Country
Customer Type

DEVICE SELECTION

Weberneedle Endolaser — Approx. $55,000
WeberBrain Pro — $15,000
WeberBrain Home — $5,000
EndoLight — $1,975

ACCESSORIES & CONSUMABLES

Selection

PAYMENT

Check to request for
Purchase Options
Communication
I would like to learn more about

CUSTOMER ACKNOWLEDGMENT

By submitting this request, I understand that this form is an inquiry and does not constitute a final purchase agreement.

I acknowledge that:

  • Pricing shown is estimated and subject to final quotation.
  • Final pricing may vary based on configuration, accessories, shipping, taxes, import duties, and installation requirements.
  • Financing and leasing options are subject to approval by participating financing providers.
  • Certain products may require professional training and/or physician oversight depending on applicable regulations and intended use.
  • Product availability, delivery timelines, and installation schedules may vary.
  • AI Wellness and Weber Medical reserve the right to update pricing, specifications, financing programs, and product availability without prior notice.

PRIVACY NOTICE

The information provided on this form will be used solely to evaluate your request, prepare quotations, coordinate financing (if requested), and communicate regarding Weber Medical products and AI Wellness services. Your information will not be sold and will be handled in accordance with applicable privacy laws.

NEXT STEPS

After your form has been received:

✓ Your request will be reviewed by the AI Wellness team.

✓ An AI Wellness representative will contact you within 1–3 business days.

✓ If financing is requested, you may receive a separate financing application from an approved financing partner.

✓ A personalized quotation and recommended product configuration will be prepared based on your goals and intended use.

✓ Product demonstrations, clinical training, installation, and onboarding can be scheduled following order confirmation.