ApronCheck Customer Inquiry
1.
Who do you mainly purchase your aprons from?
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-- Please Select --
No one in particular
I don't know
Local x-ray dealer
They are not on this list (OTHER)
AADCO Medical
Bar-Ray
Burlington Med
Davis Lead Apron
INFAB Corp
Lite Tech, inc
Marshield
PROTECH
Pulse Medical Inc
Shielding Int
Techno-Aide, Inc.
Wolf X-Ray Corp
2.
How many imaging exams does your facility perform a year?
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3.
Check all the boxes that describe you and your duties and responsibilities regarding lead aprons
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Select at least 1 response.
The person that actually performs the inspections.
Department manager/supervisor
Assistant Department Director
Department Director
Person ultimately responsible for the lead apron inspection program at my facility
Radiation Safety Officer
Medical physicist
Other, please specify
4.
How did you find out about ApronCheck?
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Please check all that apply Select at least 1 response.
Internet search engine
Direct mailing
Magazine ad
Trade show
Word-of-mouth
Internet newsgroup/blog
Another web site
News article
Other, please specify
5.
Facility Name:
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6.
First Name:
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7.
Last Name:
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8.
Title / Position:
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9.
Phone Number:
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10.
Street Address:
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11.
City:
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12.
State:
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13.
Zip Code:
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14.
E-mail Address:
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