Request Dicom scan from Archive - Philips scanner

This form should be used to request a Dicom fMRI scan from the Philips scanner archive. Please submit this form for each scan request.

Please fill in all the fields below before submitting the form.

All requested data will be copied to the requesters PBIC home folder by default with the Registration_ID as the folder name. If you wish the data to be copied to remote media or USB device you will be requested to provide the media or device.

Requester Name:

Requester Email (Birmingham University address only)

Requester Telephone No:

Participant Registration ID:

Operator:

Project Code:

Date and Time of Scan

Year / Month / Day Hour : Minute

Restore Location:

PBIC Account
Project Folder
Remote Media or USB device

Further information: