Practice Name*
Address
Name*
Title
Email*
Referring Representative
How many nuclear cardiac studies are you performing each month?*
Who is your current radiopharmaceutical supplier?
Does your lab use:
SestamibiMyoviewBothOther
What is your current radiopharmaceutical per dose cost?
When is your current contract over?
Does your current contract have an early termination option?
LexiscanAdenosinePersantineOther
Cost per dose
In addition to radiopharmaceuticals, which other LHS services are you interested in?
StaffingPhysicist ServicesSPECT System ServiceUltraSPECT – Time/Dose Reduction SoftwareBadge Services
Number of SPECT system(s)
Type of SPECT system(s)
*Required field
