I Would Like To Receive:
Product Literature
Written Quotation

Please send specific information for:
Radiotherapy simulators
Shielding block cutters
Beam compensator milling systems
X-ray cassette holders
Breast incline board
Radiotherapy thermoplastic
Calipers
Head & neck immobilization
Foam blocks, alloy, other supplies

I'm also interested in receiving a complete information package for:
Radiotherapy product line
Remanufactured diagnostic imaging systems
X-ray collimators

(list additional interests in text box provided below)

First Name

Last Name

Middle Initial

Title

Organization

Work Phone

Fax

E-mail Address (required)

Street Address

City

State

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Country

The above information is also my “ship to” address:
yes no (If no, please provide “ship to” in text box provided below)

Please contact me via:
e-mail fax mail

I would also like someone to call me:
yes no

My facility's power supply is:
Single Phase
Three Phase

The available room dimensions are:
wide
long
feet meters

Please enter quantity and select simulator and generator options.
(enter qty.) Radiographic/Fluoroscopic Simulator I'm Not Sure - Please Assist Me Custom Model Not Listed
(enter qty.) 50 kW, Three-phase generator 65 kW, Three-phase generator 40 kW, Single-phase generator I'm Not sure - Please Assist Me Custom Model Not Listed

Please choose from our list of available simulator options.
Digital Imaging
12” Image Intensifier
Couch Floor Rails
Epoxy Floor Leveling (for couch rails)

Please choose from our list of available accessory options.
Cassette Adapter Inserts
Additional Block Tray Adapter
Additional Lasers
Service Options

Additional quote items or comments may be listed in the text box provided below.

I first learned of Huestis Medical from:

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Choose Magazine Advance for AR Green Journal - Rad & Onc Medical Dosimetry Medical Imaging Medical Physics Medical Physics World MEEN -ITN Radiation Therapist Red Journal - IJROBP 24 x 7 Other

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