DIAGNOSTIX PLUS, INC. Please fill out as much of the form below as possible if you have a Siemens camera for sale.

Facility or Selling Company
Address
Contact Person:
Phone:
Fax:
When is the system available?
Is it owned or leased?	Date of Installation:
Model # or name:
SPECT or Non SPECT	Age of System:
Stand Type: Choose one Digitrac Non Digitrac Unsure
Software Version:
# of Detectors:
# of PMTs per detector:
Size and Shape of FOV:
Does is have whole body?	Storage size of Hard Disk:
Thickness of crystal:	Does the camera have the Original Crystal or has it been replaced?
Which collimators and condition:
If there is a pinhole collimator, how many apertures?
Is a SPECT table included?
	Manual or Electric
Computer software version:
Any special programs?
What size color display?
What model color printer?
What model of photography?
Any hand controls?
What model ECG Trigger?
Any major problems or repairs?
Has it been under continuous service coverage? With whom?
Is the system installed?
Please provide your email address: