Intake form

Help us serve you better

Name *

Email address *

What is your preferred method of communication?

Phone number

What services are you interested in?

Please select at least one option.

Installation of Medical Equipment

Emergency Maintenance or Preventive Maintenance

Which medical equipment are you inquiring about?

Please select at least one option.

GE's CT Scans

GE's PET Scans

When do you need the services to be completed? *

Do you have any specific requirements or specifications for the project?

Additional questions or comments

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