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Rad Room Valuation or Trade-in Form

Facility / OEM / Owner:
Address:
Phone:
Contact:
Manufacturer:
Model:
Date of manufacture:
Generator model:
Mas:
Kvp:
Phase:
High frequency?
Table model:
Table tilt:
Table movement 1:
Table movement 2:
Tube model:
Tube position:
Has the tube ever been replaced? If so when?
Collimators:
Is the system phototimed?
Does the system have tomography?
Digital: (List software level)
Is the system remote?
List any accessories or other components such as wall bucky or wall holder:
Does the system have any operating problems? If so describe:
Cosmetic condition:
Operational condition:
Who is servicing the system?
When is the system available for removal?
Do not enter anything in this field:


Currently Looking to Purchase:
  • GE CT Scanners
  • Multi-Slice CT
  • CR Units
  • Open MRIs
  • HF Rad Rooms

 

    Now Available:
    • GE Light Speed 16
    • GE QX/i 4
    • GE NX/i Dual
    • Philips Brilliance 64
    • GE 1.5 Shortbore Mobile
    • Siemens Symphony

     


      Clinical Imaging Systems, Inc.
      522 Highway 9 North Suite 321
      Manalapan, NJ 07726  
      Toll Free: 1-866-585-7164
      Phone: 1-732-591-9510  
      Fax: 1-732-226-3168
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