SwiftMR™ Trial | Complete Your Pre-Installation Survey

SwiftMR™ Pre-Installation Survey

To ensure a smooth installation of our SwiftMR solution at your site, please complete the following form with the necessary details. Please complete a separate form for each site (location) to ensure we have the necessary details for an efficient installation process.

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Device Your Point

Your Information

Please provide your name and contact information.

Your Name

First

Last

Phone

Site Details

Please provide the site name and address.

Site Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Point of Contact

Please provide the name and contact information for the POC at the site.

Are you the point of contact (POC) for this installation?

Installation Scheduling

Please provide your two preferred weeks for the installation. Note that the schedule can only be booked up to two weeks in advance.

Preferred Week #1

Preferred Week #2

Assigned Static IP Information

Please provide the following requested information. IP must be on network that can communication to scanner, PACS, and to the internet.

IP Address

Subnet

Gateway IP

DNS

PACS Information

Please provide the IP, AE title, and port details for your PACS.

Name of the PACS Vendor

IP Address

AE Title

Port

MRI Information

Please provide details for each MRI scanner, including vendor, model, year, serial number, and networking information (IP, AE, and port).

How many scanners will be installed during this demo?

One (1)
Two (2)

MRI Scanner #1

Please provide details for each MRI scanner, including vendor, model, year, serial number, and networking information (IP, AE, and port).

Vendor

Model

Year

Device Serial Number

IP Address

AE Title

Port

Protocols

Please provide 5-7 protocols for the demo, such as Brain Routine or Lumbar Spine W/WO.

List of Protocols

SwiftMR™ Pre-Installation Survey

Your Information

Site Details

Point of Contact

Installation Scheduling

Assigned Static IP Information

PACS Information

MRI Information

MRI Scanner #1

MRI Scanner #2

Protocols

Language