Warranty Information - Bionix Radiation Therapy
First Name
*
Last Name
*
Work Email
*
Job Description
*
ADON
APRN
AUD
Administrator
CHIEF THERAPIST
CONSUMER
DO
DON
Dosimetrist
ELECTRICAN
ENGINEER
Environmental Services
Facility
LPN
Lead Therapist
MA
MD
MEDICAL DIRECTOR
Manager
NP
OFFICE MANAGER
OT
Other
PA
PT
PURCHASING
Physicist
Plant Ops
RAD Oncologist
RAD Therapist
RESIDENTS
RN
SLP
Sales Rep
Supervisor
Technician
What type of facility do you work in?
*
Contractor
Hospital/Medical Center
Long Term Care
Other
Distributor
Free Standing Clinic - RT Only
Home Health
Primary Care/General Practice Office
Retail Clinic
Urgent Care Clinic
VA or Military Hospital
Facility Name
*
Facility Address
*
City
*
State
*
Zip Code
*
Country
*
Work Phone
*
Fax
Choose the product you are requesting a warranty for. Please include the Serial Number & Purchase Date.
Acrylic CF Butterfly Boards
Comforthold Thigh and Foot Positioner
Max3 Plus
Max3
Omni V SBRT System
Pelvis Belly Board
Prone Breast System
SecureVac Cushions
T-Form Extremity Immobilizer
T-Form Head & Neck Immobilizer
VersaBoard Ultra
Waterbath