PHSA Mobile CT Trailer Request Form
Please select your Health Authority
Fraser Health
Interior Health
Island Health
Northern Health
Providence Health Care
Provincial Health Services Authority
Vancouver Coastal Health
*
Please provide your site and contact information
Name
Title
*
Site
*
Site address
*
Phone number
*
Email
*
Please select your reason for request
Select:
CT Replacement
CT Refurbishment
CT Unexpected Downtime
Other
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Requested date for trailer arrival
*
Expected date for trailer departure
Additional comments