Quote request: Ultrasound Quality Assurance

Quote request: Ultrasound Quality Assurance Testing

Name of Hospital/Clinic/Organisation*

Type of organisation:*

Please select from the following:HospitalPrivate clinicGP SurgeryOther

Other:

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:

B - Number of systems requiring Doppler testing

Total number of transducers:

Electrical Safety:

C - 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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---Yes please!No thank you.