Genesis Medical Imaging, Inc. - CT and MRI Equipment, Parts, Service and Mobiles

MRI Equipment Request Form
This form will be emailed to our Sales Department.
A sales person will contact you shortly reqarding your request. Thank you.
Questions?? Please contact Ron Ragan at (847) 961-6200
or email: RRagan@GenesisMedicalimaging.com

Customer Information
*Buyer’s Name:
Title:
*Phone:
Fax:
*E-Mail:

Facility
*Facility Name:
*Address:
*City:
*State:

How did you hear of Genesis:
Equip. Need Date:
Special Needs:
Budgeted Dollars:

Shielded MRI Systems: :
Signa 5X Series
Signa Horizon Series
Signa LX Series
1.0T
1.5T
UnShielded Option
No Phased Array

Open MRI Systems:
.2T Profile MRI
.7T Open Speed

Mobile MRI Systems:
.5T Baby Signa
1.0T Active Shield
1.5T Non-Active
1.5T Active Shield
1.5T LX Series
.5T Contour

Coil Selection:
Wrist
Neck
Head
Body
Knee
Spine
Shoulder
Breast
Quad CTL
GP Flex
Posterior
3" TMJ
Extremity
Neuro V
CTL 3" Round

Software Selection:
2D / 3D FSE
FlAIR
IVI
EPI
CINE
TOF
Phase Con
Fast Gradient
Time of Flight Vasc.
Fast SPGR / GRE
Cardiac Gating
Smart Prep
Perfusion
Diffusion
Connect Pro

Additional Options:
Lease: Term (Yrs):
% Buy Based on Price:
% Buy Based on Feature:
% Buy Based on Service:
Room Drawing:    Planning:
Long Bore    Short Bore:
Slew Rate: 70    120
Gradient Strength:
Cryogen/Magnet Service:
As Is, Where Is Condition:
90 Day Warranty:
1 Year Warranty:
Service Contract:

* Required Fields

Genesis Medical Imaging, Inc. 12031 Smith Drive Huntley, IL 60142
Tel: 847-961-6200 Fax: 847-961-6030 Service: 888-891-6990 sales@genesismedicalimaging.com