Request Medical Service Call

Please provide the following site information, contact information and answers to the four questions below. Then click Submit and we’ll get back to you shortly.

Medical Service Call Request

Site Number

Site Name *

Site Address *

Site Address

City

State/Province

Zip/Postal

Country

Chiller Model (if available)

Chiller Serial # (if available)

Contact Name *

Contact Email *

Contact Phone Number *

Position

Zip Code *

1. Is the chiller down? *

Yes

2. Is the modality (MR/CT) functional? *

Yes

3. Has the site experienced power issues? *

Yes

4. Does the chiller display show any alarms? If so, what are they? *

Yes

Please describe any alarms here.

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Grant Consent *

I grant Glen Dimplex Thermal Solutions consent to collect my name, address, phone and email.

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