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To save time completing this request form, existing users can log in to the User Portal here.

If you don't have portal access but your insitution has an RTF number, click here

(this will prepopulate much of the form data from your institution)

Phantom Request


RTF No
Request Type
Phantom Requested
Using the control key while highlighting phantoms allows a request for more than one phantom type.
Typically, phantom results are available 5-6 weeks after the date of the phantom irradiation... Would you like to order expedited service for a fee of $500?
Voucher #

Demographics

Institution
Physicist first name
Physicist last name
Physicist phone number
Physicist email

Shipping To

Is this a new address
Department
Street Address
City
State/Province
Zip Code:
Country
Is the machine physically located at the address above? (y/n)
Machine Address
Name of Facility
Method to account for respiratory motion
Protocol to be credentialed for

Machine

Machine
Machine Serial Number
Select Beam
If this is a new machine please list all energies (photon and electron) for this machine

Treatment Planning System

Model
Software Version
Algorithm used

Billing

Name
Street Address
City
Zip code

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Institution Name
RTF
City
State/Provence
Zip
Country

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