Devices that receive XRV Tags: CR, DR, Xray Control, Dental, Processor, Ultrasound, Biomed, Digitizers, Printers, DEXA. Devices that DO NOT receive XRV Tags: X-ray Tubes, Collimators, Tubestands, Tables, Power Modules.

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Required field*

XRVTag:*

Your Email:*

Reason for New Sticker:*

Contact

Facility/Clinic*

Shipment #

Address

Contact Email

Contact Phone

Equipment Type:*

Equipment Manufacturer*

Model*

Serial

Reference # (K #)

Location (ie. Room 1)

Manufacture Date

Install Date

Notes (Info on Secondary Components):