Quote request: Ultrasound Quality Assurance

Quote request: Ultrasound Quality Assurance Testing

Name of Hospital/Clinic/Organisation*

Type of organisation:*

HospitalPrivate ClinicGP SurgeryOtherOther:

Departments/ speciality:

Details of Ultrasound Systems:

Total number of systems for testing*:

Are all the systems on one site?
Please selectYesNo

If no, how many sites and what is the distance between them?

B-scan:

Number of systems requiring B-scan testing:*

Total number of transducers:*

Doppler:

Number of systems requiring Doppler testing:*

Total number of transducers:*

Electrical Safety:

Number of systems requiring Electrical Safety testing:*

Please give any additional information; eg: availability:*

Contact details

Title:*

First Name:*

Last name:*

Job Title:*

Email*:

Telephone* (inc. codes):

Speciality:*

Name of Hospital/Clinic/Organisation:*

Address*:    Hospital/ OrganisationHome

City/Town:*

Postcode:*

Country:*

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