REPULS Deployment Use Form “REPULS®” Deployment Usage FormThe purpose of this form is to gather deployment information to help us to improve our products and our training. All organization information will be confidential unless permission is expressly requested by Crotega and granted by the submitting organization. First NameLast NameTitleEmailOrganization NameOrganization Address CityStateZip CodeDate UsedWas REPULS Used on an Animal? Yes NoWhat Type of Animal? Bear Dog OtherDescribe what it was used onWas REPULS Deployed on an Individual? Yes NoWas the Individual Under the Influence of Alcohol or Drugs? Yes No UnknownWas REPULS Successful with closing the Individual's Eyes? Yes NoDid REPLUS contribute to gaining compliance from the Individual? Yes NoWas the Deployment Captured on Video? Yes NoPlease share your VideoClick Here to Upload your Video Please Provide Any Additional Information/Comments Below:Submit
