Phantom/Ex Vivo Scanning Request Form – MRI / PET / TMS Operations

PLEASE READ THE FOLLOWING DOCUMENT SAFETY AND COVID-19 GUIDELINES BEFORE FILLING OUT THIS FORM.

Requester's Email Address *

PI's First Name *

PI's Last Name *

Project Code *

Code you will use to login to the scanner

Phantom or Ex Vivo *

What Kind of Phantom? *

Which Bay? *

Slot Length (hours) *

Time Constraints (dates) *

Operations team set up or lab set up *

What type of Phantom and what type of Coil are required? *

COVID-19 Attestation *

Scheduling Policy Attestation *