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?
Does your lab use: 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
