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Mammography Tubes Housing

Tubes must be prepaid with a completed Tube Service Report describing the reason for return, operating conditions, Installed and removal dates in order to recieve Warranty consideration.

* Required Fields
Salutation
* First Name
* Last Name
* Phone:
* Email:
* Date: Ex. MM/DD/YYYY
  * Dealer       * OEM
* Dealer/OEM:
Address:
* City:
* State/Province:
Postal Code:
* Country:
* Institution:
(Where Tube Installed)
Address:
* City:
* State:
Postal Code:
* Country:
Fax:
Return Tube Information
* X-ray Tube Type: * Serial Number:

Dates
* Tube Received
Ex. MM/DD/YYYY 		* Tube Installed
Ex. MM/DD/YYYY
* Tube Removed
Ex. MM/DD/YYYY

* Reason for removal of service:

Manufacturer of Generator: Manufacturer Type:

* Type of Circuit
Single Phase: Three Phase:
Single Phase Cap Smooth: High Frequency:

* Number of Exposures:    
Techniques at Time of Difficulty
* kV * mA * Time
Techniques Most Frequently Used
* kV * mA * Time
Maximum Exposure Techniques Used
* Max kV used: * Max mA used:

High voltage cables/components replaced monthly?    Yes    No

Have there been previous tube failures?    Yes    No

   If so, when and for what reason?

Replacement Tube Type
* Insert Model: * Serial Number:

Additional Comments:

 

    

Email by clicking Submit or Print and Fax to 801.973.5050

 
 

 

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Production of any of the material contained herein in any format or media without the express written permission of Varian Medical Systems is prohibited.

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