3B Scientific Digital Order Form v1

  • 3B Scientific Digital Order Form

    3B Scientific values your business! Please complete and review this digital order form checklist in it's entirety to help our team build your 3B Scientific product accordingly. Please note, these products are handcrafted by Special Effects Artists and results may vary. A copy of your responses will be sent to your provided email. Some optional product additions result in additional costs(s) as noted. Please ensure any additions are reflected on the purchase order provided to 3B Scientific.

  • Contact Information:

  • Which Product Are You Purchasing?

    Which Product Are You Purchasing?

    Please select one (1) per digital order form.
  • Select Your 3B Scientific Product (one per form):*
  • Lifecast Manikin Order Form

    Lifecast Manikin Order Form

  • Please select which Lifecast Manikin you are building your digital order form for:

  • Ethnicity & Skin Undertone

    Please take a moment to describe your manikin's ethnicity. You may also write "Not Applicable."

  • Would You Like to Purchase a Stretcher for your Manikin to Ship On?*

  • Attire:

  • Select Your Manikin's Attire:*
  • Lifecast Manikin Order Form Female Features

    Lifecast Manikin Order Form Female Features

    Please select the features you would like on your Lifecast Female Manikin

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Color*
  • Hair Length*
  • Hair Style*
  • Body Hair - All are standard. You may choose multiple options.*
  • Lifecast Manikin Order Form Male Features

    Lifecast Manikin Order Form Male Features

    Please select the features you would like on your Lifecast Male Manikin

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Color*
  • Hair Length*
  • Hair Style*
  • Body Hair - All are standard. You may choose multiple options.*
  • Lifecast Manikin Order Form Gender Transitioning Manikin Features

    Lifecast Manikin Order Form Gender Transitioning Manikin Features

    Please select the features you would like on your Lifecast Gender Transitioning Manikin. * The manikin will include the following features: reduced testical size, tracheal shave surgery, lip filler, hairline advancement surgery, thinned eyebrows.

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Color*
  • Hair Length*
  • Hair Style*

  • Additional Features

  • To personalize your manikin, please choose the options you wish to include. Additional costs apply. You may select multiple options.*
  • Lifecast Manikin Order Form Female Child Features

    Lifecast Manikin Order Form Female Child Features

    Please select the features you would like on your Lifecast Female Child Manikin.

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Color*
  • Hair Style*
  • Lifecast Manikin Order Form Toddler Features

    Lifecast Manikin Order Form Toddler Features

    Please select the features you would like on your Lifecast Toddler Manikin. *NOTE the toddler does not have nasal access
  • Lifecast Toddler Model (price varies)*
  • You may add IO access at no additional cost*

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Color*
  • Hair Style*
  • Lifecast Manikin Order Form 3 - 6 Month Infant Features

    Lifecast Manikin Order Form 3 - 6 Month Infant Features

    Please select the features you would like on your Lifecast 3-6 Month Infant Manikin.
  • Intraosseous (IO Access): You may choose one or both at no additional cost*

  • Eyes

    Open eyes remain open. Closed eyes have the ability to manually lift open and will revert back to the closed position.

  • Eye Type*
  • Eye Color*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Type*
  • Hair Color*
  • Lifecast Manikin Order Form Full Term Baby Features

    Lifecast Manikin Order Form Full Term Baby Features

    Please select the features you would like on your Lifecast Full Term Baby Manikin.
  • You may add IO access at no additional cost*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Type*
  • Hair Color*

  • Belly Button

  • Would you like your Baby manikin to have a belly button (Additional cost applies)?
  • Lifecast Manikin Order Form Premature Baby Features

    Lifecast Manikin Order Form Premature Baby Features

    Please select the features you would like on your Lifecast Premature Baby Manikin.
  • Gender*

  • Hair

    All standard bodies come with eyebrows and eyelashes.

  • Hair Type*
  • Hair Color*

  • Belly Button

  • Would you like your Baby manikin to have a belly button (Additional cost applies)?
  • Lifecast Manikin Order Form Additional Features

    Lifecast Manikin Order Form Additional Features

    Please select the additional features you would like on your Lifecast Manikin. NOTE: All Additional Features do result in additional cost. Please consult with your Sales Representative regarding pricing.

  • Additional Features (additional cost applies)

    An additional feature may result in additional production time. We recommend submitting a photo reference in the final section of the form; however in the absence of photos, the artist will use their discretion.

  • Would you like to add additional feature(s)?*
  • Your Lifecast Manikin comes standard with foley catheter function, unless you opt out of having this feature included. Would you like your manikin to include the standard foley catheterization?*
  • Your Lifecast Manikin comes standard with foley catheter function, unless you opt out of having this feature included. Would you like your manikin to include the standard foley catheterization?*
  • Level 1 Superficial Cosmetic Additions (You may choose multiple options. Additional cost applies.):
  • Specialized Eyes*
  • Brusing Type*
  • Select Skin Blemish Type(s) (you may choose multiple options):*
  • Level 2 Superficial Cosmetic Additions (You may choose multiple options. Additional cost applies.):
  • Mastectomy Scar (Specify Unilateral or Bilateral)*
  • Level 2 Advanced Clinical Additions (You may choose multiple options. Additional cost applies.):
  • Level 3 Superficial Cosmetic Additions (You may choose multiple options. Additional cost applies.):
  • Level 3 Advanced Clinical Additions (You may choose multiple options. Additional cost applies.):
  • Level 3 Central Line Additions (Additional costs apply). You may select multiple options for central lines, however only 1 central line option can be placed in each location on the manikin.
  • PICC Line Location(s) - You may select 1 or both locations. Please note that you can only have 1 type of central line placed in each location on your manikin.*
  • Non-Tunneled Catheter Location(s) - You may select multiple options. Please note that you can only have 1 type of central line placed in each location on your manikin.*
  • Port-A-Cath Single Lumen Subdermal Port Location(s) - You may select multiple options. Please note that you can only have 1 type of central line placed in each location on your manikin. Also note that if you use fluids, use treated water, saline solution or 99% Isopropyl Alcohol.*
  • Who will provide the single lumen ports for your Port-A-Cath feature on your manikin?*
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  • EchoMask Order Form

    EchoMask Order Form

  • Ethnicity & Skin Undertone

    Please take a moment to describe your EchoMask's ethnicity. You may also write "Not Applicable."

  • Chest Plate

    A chest plate will extend your EchoMask from the neck to the chest area.
    *Available only for the Middle-Aged Female EchoMasks 

  • Do you want your Middle-Aged Female EchoMask to have a chest plate?*

  • Hair

    All standard EchoMasks come with eyebrows and eyelashes.
    Hairstyles are chosen at the discretion and expertise of our artists. To ensure you receive the most appropriate style, please let us know the ethnicity of your manikin in the previous section.

    Our standard hair colors are the following:
    Young: Brown/Black hair
    Middle Aged: Salt and Pepper Hair
    Senior: Gray Hair

  • Head Hair*
  • Facial Hair*

  • Additional Features

  • Would you like to add additional feature(s) to your EchoMask?*
  • Please select which EchoMask Addition(s) you would like to add. Only 1 feature can be placed on each side of the face and 2 features maximum per mask. Specify the location of where you'd like this addition in the next section:*
  • Middle-Aged Female Additions. Only applicable if a Middle-Aged Female EchoMask was selected. Additional cost applies. You may select in conjunction with all other additions above.

  • EchoMask Stand

  • Image field 131
  • Would you like to purchase an EchoMask stand to store your mask on?*
  • SecondSkin Order Form

    SecondSkin Order Form

    Please complete and review this checklist to ensure no details are missed on your SecondSkin. This product is handcrafted by special effects artists. Results will vary. A copy of your responses will be sent to your provided email. This model is for use on the Laerdal® SimMan 3G.
  • About SecondSkin

    About SecondSkin

    The SecondSkin is a Middle-Aged (35-55 years old) Male full body skin suit handmade from prosthetic-grade silicone and includes an EchoMask. The SecondSkin is sculpted and designed as a male to fit exclusively on the Laerdal® SimMan 3G manikin. It does not work with SimMan ALS, SimMan Essential or SimMan Critical Care models. Certain functions will not operate correctly when the SecondSkin is applied (ie: foley catheterization cannot be performed).

  • Ethnicity & Skin Undertone

    Please take a moment to describe your SecondSkin's ethnicity. You may also write "Not Applicable."

  • Hair

    All standard EchoMasks come with eyebrows and eyelashes.
    Hairstyles are chosen at the discretion and expertise of our artists. To ensure you receive the most appropriate style, please let us know the ethnicity of your manikin in the previous section.

    Our standard hair colors are the following:
    Young: Brown/Black hair
    Middle Aged: Salt and Pepper Hair
    Senior: Gray Hair

  • Head Hair*
  • Facial Hair*

  • Additional Features

  • Would you like to add additional feature(s) to your SecondSkin Suit?*
  • Please select which SecondSkin Addition(s) you would like to add. The location can be anywhere front or back of the mid body (specifically thorax to low abdomen & upper thigh area).*
  • Would you like to add additional feature(s) to your EchoMask?*
  • Please select which EchoMask Addition(s) you would like to add. Only 1 feature can be placed on each side of the face and 2 features maximum per mask. Specify the location of where you'd like this addition in the next section:*
  • Middle-Aged Female Additions. Only applicable if a Middle-Aged Female EchoMask was selected. Additional cost applies. You may select in conjunction with all other additions above.

  • EchoMask Stand

  • Would you like to purchase an EchoMask stand to store your mask on?*
  • 7-SIGMA Order Form

    7-SIGMA Order Form

    Please complete and review this checklist to ensure no details are missed on your 7-SIGMA Airway Product. A copy of your responses will be sent to your provided email. NOTE: All 7-SIGMA trainers come with a 30-day manufacturer's warranty.

  • 7-SIGMA Airway Trainer Descriptions:

    • Full Torso Airway Trainers: represent an adult male. The Full Torso Airway trainer is comprised of the chest, lungs, base plate, face skin and front skill all contained (lung bags do not show).
    • Partial Torso Airway Trainers: represent an adult male. The Partial Torso Airway trainer is comprised of the chest, lungs, base plate, face skin and front skull with the lung bags exposed as shown. 
    • Burnt Victim Airway Trainers: represent an adult male and are available as a full torso or a partial torso. The Burnt Victim's face & airway simulate a real burn victim with smoke inhalation. 
    • Swollen Victim Airway Trainers: represent an adult male and are available as a full torso or partial torso. The Swollen Victim's face & tongue simulate a swollen victim from physical trauma or allergic reaction.
    • Pediatric Partial Torso Airway Trainer: represents a 5 year old female of Asian ethnicity and comes standard with an Advanced Skills Airway. The Advanced Skills Airway prioritizes simulation of human tissue’s characteristic delicacy & recreation of the anatomical structures and geometry typical of human anatomy.

     

  • 7-SIGMA Adult Airway Order Form

    7-SIGMA Adult Airway Order Form

    Please complete and review this checklist to ensure no details are missed on your 7-SIGMA Airway Product. A copy of your responses will be sent to your provided email. NOTE: All 7-SIGMA trainers come with a 30-day manufacturer's warranty.

  • Airway Type

  • Select the type of airway you would like included in your 7-SIGMA Airway Trainer:*

  • Optional Replacements & Add-Ons

    *Additional charges apply

  • Would you like to add additional items to your 7-SIGMA Airway Trainer?*

  • Carrying Cases

    *Additional charges apply

  • Add On: Carrying Case (you may select multiple)

  • Skills Kits

    Skills Kit(s) include a head skin and complete airway assembly and are designed to give a single airway trainer multiple airway type(s) by easily swapping them out.
    *Additional charges apply

  • Add On: Skills Kit (you may select multiple)

  • Head Skins

    Includes a head skin for your trainer without the interchangeable airway assembly that comes with the Skills Kit. This will give your trainer a different appearance while using the airway type(s) you already own.
    *Additional charges apply

  • Add On: Head Skin

  • Complete Airway Assembly

    Includes an airway, upper teeth, lower teeth, jaw, jaw brackets and plastic nasal holder. This allows you to swap out the airway type on your modular 7-SIGMA trainer for airway variation and pathology options.
    *Additional charges apply

  • Add On: Complete Airway Assembly

  • Base Airway

    Includes a base airway without the additional modular components of the Complete Airway Assembly.
    *Additional charges apply

  • Add On: Base Airway

  • Teeth

    Includes teeth without the additional modular components included in the Complete Airway Assembly.
    *Additional charges apply

  • Add On: Teeth
  • 7-SIGMA Pediatric Order Form

    7-SIGMA Pediatric Order Form

    Please complete and review this checklist to ensure no details are missed on your 7-SIGMA Airway Product. A copy of your responses will be sent to your provided email. NOTE: All 7-SIGMA trainers come with a 30-day manufacturer's warranty.

  • Pediatric Partial Airway Trainer

    The 7-SIGMA Pediatric Partial Torso Airway Trainer represents a 5 year old female of Asian ethnicity and comes standard with an Advanced Skills Airway. The Advanced Skills Airway prioritizes simulation of human tissue’s characteristic delicacy & recreation of the anatomical structures and geometry typical of human anatomy.

  • Optional Replacements & Add-Ons

    *Additional charges apply

  • Would you like to add additional items to your 7-SIGMA Airway Trainer?*

  • Carrying Cases

    *Additional charges apply

  • Base Airway

    Includes a base airway without the additional modular components of the Complete Airway Assembly.
    *Additional charges apply

  • Teeth

    Includes teeth without the additional modular components included in the Complete Airway Assembly.
    *Additional charges apply

  • Add On: Teeth
  • 7-SIGMA Order Form Optional Additions

    7-SIGMA Order Form Optional Additions

    Please complete and review this checklist to ensure no details are missed on your 7-SIGMA Airway Product. A copy of your responses will be sent to your provided email. NOTE: All 7-SIGMA trainers come with a 30-day manufacturer's warranty.

  • COVID-19 Skills

    Includes airway contaminant supplies to simulate respiratory scenarios on your trainer.
    *Additional charges apply

  • Add On: COVID-19 Skills*

  • Cricoid Skills

    The modular Cricoid Skills Trainer is a light weight modular trainer that offers an efficient tool for teaching both Cricothyroidotomy and Suturing. This device works in tandem with the 7S³ Skin Strips.
    *Additional charges apply

  • Add On: Cricoid Skills*
  • Immersive Interactive Order Form

    Immersive Interactive Order Form

    Please complete and review this checklist to ensure no details are missed on your Immersive Interactive Room. A copy of your responses will be sent to your provided email.

  • Room Configuration:

  • Package Tier:

  • Content Package Tier:

  • Add Ons:

  • Please select any additional items you would like included in your Immersive Interactive system.*Additional charges apply*

  • Scents:

    The optional scent feature allows you to simulate smell(s) related to the simulated environments you are creating in your Immersive Interactive room. 3 scents are included with the purchase of the Scent Diffuser.
    *Additional charges apply

  • Select Your Scents 3 scents are included with the Add On Scent Diffuser. Any additional scents will be an added cost.*
  • iSimulate Order Form

    iSimulate Order Form

    Please complete and review this checklist to ensure no details are missed on your iSimulate product. A copy of your responses will be sent to your provided email.

  • iSimulate License Contact Information:

    Please include the contact information of the person you would like the iSimulate license(s) to be sent to electronically.
  • Format: (000) 000-0000.

  • Build Your iSimulate Package:

  • iSimulate Training:*
  • iSimulate Scenario Creation:*


  • MeLiSA Service & Support

    1 year of MeLiSA Service is included with your purchase. Select if you would like the standard or would like to add additional year(s) of MeLiSA service.

  • How Many Year(s) of MeLiSA Would You Like Included with Your Purchase?*


  • MeLiSA Service & Support

    60 days of MeLiSA Service is included with your purchase. Select if you would like the standard or would like to add additional year(s) of MeLiSA service.

  • How Many Year(s) of MeLiSA Would You Like Included with Your Purchase?*


  • MeLiSA Service & Support

    30 days of MeLiSA Service is included with your purchase. Select if you would like the standard or would like to add additional year(s) of MeLiSA service.

  • How Many Year(s) of MeLiSA Would You Like Included with Your Purchase?*


  • Signature

    This digital order form will be paired with a provided purchase order that would confirm your purchase. By signing below, I acknowledge that I have reviewed this order form and all of the information I have provided is correct for 3B Scientific to build my product according to this completed digital order form and the provided purchase order.

  • Date Signed:*
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