Sign up as a new customer

You can sign up for any of our products by filling out the New User Registration form below.

By filling out the New User Registration form, you are entering into a contract with Resonance Health Analysis Services Pty Ltd. Please ensure you are authorised to enter into contracts on behalf of the User before proceeding.

"*" indicates required fields

Step 1 of 9

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New User Details

Contracting Party (“User”):*

(Please insert User’s full legal name. E.g.: Hospital Inc. / Imaging Centre Pty Ltd / Imaging Centre LLC)

Please select which type of entity the User is*

Pty Ltd / Proprietary Limited

Ltd / Limited

Inc.

LLC

PLC

Trust

Other

User's ACN/ABN or other registration number:*

User's ACN/ABN or other registration number:

Contact Name:*

First

Position Title:*

Email Address:*

Department:*

Primary Address:*

(Scanner verification Phantom will be delivered here – for FerriScan®)

Street Address Suburb / Town State ZIP / Postal Code Country

Telephone:*

(with area code)

Who will be the User’s Primary Technical Contact? The Primary Technical Contact will be responsible for technical communications with us and, if applicable, the scanning of the FerriScan Phantom (or test patient) to verify that the correct acquisition protocol has been set up.

Contact Name (include title):*

First

Email Address:*

Position Title:*

Billing Information:

Is the billing info different from the primary address?*

Yes

Needed for delivery of invoices

Contact Name:*

First

Position Title:*

Email Address:*

Department:*

Products:

Which Products do you intend to use?*

FerriScan

FerriSmart

CardiacT2*

BoneMarrow R2

LiverSmart

HFSmart

OrganVolume

*additional Products can be added following sign-up, if required

Fees and Payment:

User region (country):*

Country

Applicable currency:*

USD

GBP

EUR

AUD

Current Price List is applicable unless otherwise agreed upon in writing. Fees will be provided upon request and confirmed at the time of execution of this New User Registration.

Customer Terms & Conditions:

Consent*

By signing below, the User agrees to the Customer Terms & Conditions (updated by us from time to time via our website), the latest version of which is viewable and downloadable here. https://www.resonancehealth.com/storage/LEGAL-3-General-Terms-and-Conditions-v3.0.pdf

I have read and agree to Resonance Health’s Standard Terms and Conditions.

Executed for and on behalf of the User as an Agreement by its duly authorised representative:*

Day

Month

Year

Signature:*

Electronic signature of:*

First

Position Title:*

Annexure A: User Portal Access Form

User Portal Registered User Details (Due to Patient privacy requirements, only email addresses issued by your workplace will be accepted).

Site Name:*

Title:*

Prefix

Name:*

First Surname

Job Title:*

Phone:*

(with area code)

Email:*

Patient Report Access Level*

Read & download

Lodge, read & download

User Portal Authoriser*

*A User Portal Authoriser is a person who is authorised to approve or revise Registered Users of the User Portal. As access to our User Portal is required to upload Patient Images and to access Reports, all requests for access must be approved by this/these authorised person(s).

Add Another User?*

Yes

Title:*

Prefix

Name:*

First Surname

Job Title:*

Phone:*

(with area code)

Email:*

Patient Report Access Level*

Read & download

Lodge, read & download

User Portal Authoriser*

Add Another User?*

Yes

Title:*

Prefix

Name:*

First Last

Job Title:*

Phone:*

(with area code)

Email:*

Patient Report Access Level*

Read & download

Lodge, read & download

User Portal Authoriser*

Signed by User Portal Authoriser:*

Electronic signature of (insert name):*

First

Position Title:*

Date*

Day

Month

Year

Annexure B: Scanner Registration

Scanner Details

Scanner location and Phantom delivery address:*

Street Address Suburb / Town State ZIP / Postal Code Country

Manufacturer:*

Siemens

Philips

Other

If other pls specify:*

Model:*

Serial number if known:

Field strength:*

1.5T (All Products)

3T (Only available for FerriScan, LiverSmart and HFSmart)

Can your Scanner achieve a min TE of 6.0ms (1.5T) or 5.0 – 6.0ms (3T) with a T2-weighted single spin echo (SE) sequence? (NOT TSE or FSE or GRE sequence)*

Yes

Unsure

Is your 3T Scanner equipped with a dual transmission system or a single transmission system?*

Dual Transmission System

Single Transmission System

Unsure

Is your Scanner equipped with an ECG facility and a cardiac package with a multiple-echo T2* sequence?*

Yes

Is your scanner able to achieve a minimum TE≤3ms (1st TE) and a maximum TE≥15ms (8th TE) with a multi-echo gradient echo sequence?*

Yes

Unsure

Do you want to register another scanner?*

Yes

Manufacturer:*

Siemens

Philips

Other

If other pls specify:*

Model:*

Serial number if known:

Field strength:*

1.5T (All Products)

3T (Only available for FerriScan, LiverSmart and HFSmart)

Can your Scanner achieve a min TE of 6.0ms (1.5T) or 5.0 – 6.0ms (3T) with a T2-weighted single spin echo (SE) sequence? (NOT TSE or FSE or GRE sequence)?*

Yes

Unsure

Is your 3T Scanner equipped with a dual transmission system or a single transmission system?*

Dual Transmission System

Single Transmission System

Unsure

Is your Scanner equipped with an ECG facility and a cardiac package with a multiple-echo T2* sequence?*

Yes

Is your scanner able to achieve a minimum TE≤3ms (1st TE) and a maximum TE≥15ms (8th TE) with a multi-echo gradient echo sequence?*

Yes

Unsure

Do you want to register another scanner?*

Yes

Manufacturer:*

Siemens

Philips

Other

If other pls specify:*

Model:*

Serial number if known:

Field strength:*

1.5T (All Products)

3T (Only available for FerriScan, LiverSmart and HFSmart)

Can your Scanner achieve a min TE of 6.0ms (1.5T) or 5.0 – 6.0ms (3T) with a T2-weighted single spin echo (SE) sequence? (NOT TSE or FSE or GRE sequence)?*

Yes

Unsure

Is your 3T Scanner equipped with a dual transmission system or a single transmission system?*

Dual Transmission System

Single Transmission System

Unsure

Is your Scanner equipped with an ECG facility and a cardiac package with a multiple-echo T2* sequence?*

Yes

Is your scanner able to achieve a minimum TE≤3ms (1st TE) and a maximum TE≥15ms (8th TE) with a multi-echo gradient echo sequence?*

Yes

Unsure

Complete the last step to submit the form

Prevent spam*

To send the form, please answer this question to help prevent spam: A panda is black and …..

Consent

I agree to the privacy policy.

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

Sign up as a new customer

You can sign up for any of our products by filling out the New User Registration form below.

Subscribe To Our Newsletter

Address

Call Us

Email Us

How Cardiac T2* Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

How HepaFatScan® Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

How LiverSmart® Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

How HepaFatSmart® Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

How FerriSmart ® Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

How FerriScan® Works

1. Patient Referred

2. DICOMs Transferred

3. Analysis Performed

4. Results Returned

Sign up as a new customer

You can sign up for any of our products by filling out the New User Registration form below.

Subscribe To Our Newsletter

Address

Call Us

Email Us