Equipment ROI & Analysis Request

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"*" indicates required fields

Name*

First Last

Date*

Email*

Equipment Information

Manufacturer*

Year*

Modality*

Model*

What ROI would you like to see?*

3 Years

5 Years

10 Years

What is the average amount of scans performed per year with this machine?*

What are your top 5 major exams performed?*

Additional Comments (if applicable)