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What can we help you with today?
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MRI Coil Repair Form
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Facility Name
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Coil Information
Model Number:
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Serial Number:
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Coil Description:
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MRI Frequency:
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T
Problem Description
Brief description of problem:
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Is the problem:
Intermittent
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Happened once or Don't know
Additional information
Will not scan
High Noise or Grainy Images
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Mechanical Problem(Please specify below)
For Artifacts:
Localized
Global Bright Area
Dark Hole
Shading
Ripple Patterns
If Homogeneity:
Poor uniformity
Fat Saturation problem
If Coil Won't Scan
TR Driver Fault
Coil not identified
No Signal or Frequency not found
Are any system error messages shown?
Other symptoms or problems:
Which section, modes, or channels?
Please specify which sections, channels, modes have the problem? (i.e., C-section on CTL coil)
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Sell Your Used Scanner
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Date of Manufacture*
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Model / Series*
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Describe Your Imaging Project and Reason for Sale
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Project Timing
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1-3 Months
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Asking Price
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Functional?
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Installed
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Site ID
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System Serial Number and Magnet Serial Number
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Magnet Type
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Coils (Please specify any multi-channel coils and number of channels)
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Slew Rate
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Software Revision Level(Options enabled on system, rev level, other features, and hardware)
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Current Service Provider
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System Location: Facility Type
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Hospital
CIF
Clinic
Loading Dock at Facility
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Diagnostic Imaging Equipment Quote Request
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