MRI Form:

Manufacturer Model Production Year
S/N SiteID Available Date
SW Rev Current Settings

Magnet Name:
Type
Magnet Design
Config/if upgrade Install Date:

Shielding

Field Strength Other:

Helium Level Last Fill: Last Cold Head Replacement:

Gradient Strength Slew Rate:
Software Level:
Computer Platform:

Permanatly Installed Software Options:

Option: Option:
Option: Option:
Option: Option:
Option: Option:
Option: Option:
Option: Option:
Option: Option:
Option:
  • All System software and service codes must be on site and provided at time of removal.
  • All system manuals (operator and technical) must be on site and provided at the time of removal.
  • All service records must be on site and provided at the time of removal.
  • All phantoms must be on site and provided at the time of removal.
Coil 1
Coil 2
Coil 3
Coil 4
Coil 5
Coil 6
Coil 7
Coil 8
Coil 9
Coil 10

Type:
Type:
Type:
Type:
Type:
Type:
Type:
Type:

This installation is:
System is:

System Details

System is in good working condition and not in need of repair?
   with:
Location in facility (room number)   on floor 
Loading dock is available? 
System being replaced by: 

Site Info

Company/Entity:
* Name/Rep: *
* Email: *
Phone:
Deal Status:
Address:
Address (cont.)
City:
State/Province:
Country:
Zip Code: