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 *

Subject Name (First Name, Last Initial) *

Which Bay? *

Slot Length and Description *

Time Constraints *

IRB/SRAC/IACUC Number *

Tech Support Needed *

Tech Support Needed *

Please describe the support needed

COVID-19 Attestation *

Scanner Safety Attestation *

My group has met with either John Kirsch, and/or Grae Arabasz to discuss scanner safety protocols.

Scheduling Policy Attestation *