Install Onboarding Form

Preparing for Your Clinical Imaging System
To ensure a seamless setup, please complete the form below. Our team will be in touch to confirm your installation and training date.

Approx. 10mins to complete
Form Completed By
Name

First NameLast Name
Email
Clinic Details
Clinic Name
Please enter name as advertised (website, social media).
Clinic Address for Install

Address Line 1

Address Line 2 (optional)

CityState

PostcodeCountry
Delivery Address
How Did You Hear About Clinical Imaging?
Referred By
Please List
Core Services (select all that apply)

Other
Capture Areas
Install Details
Install Type
Payment type
Service plans overview and inclusions
Service agreement
Number of Team Members Attending Training
Initial training is 1 hour minimum. For teams of more than 4, please allocate at least 1.5 hours.
Your remote installation will take approximately 1.5 hour. Once we confirm your install date, please schedule your electrician for the same day.
Names & Roles
We recommend that all staff handling images attend training to ensure a smooth integration.
Preferred Installation Day - we will be in contact to be as close to this day as possible.
Please allow 10 working days buffer for stock shipments to arrive in time for your installation.
Electrician Contact Details
Name & phone number
IT Contact Details
Name & phone number
Clinic Logo and / or Room tour photos

*For room tours please include wide angle of the entire space including the ceiling *Please upload your clinic logo for your imaging system software. A transparent background is recommended.
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Video tour upload

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Clinical Imaging Australia Pty Ltd
(03) 5280 8015
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Preparing for Your Clinical Imaging System

Form Completed By

Clinic Details

Install Details

Please allow 10 working days buffer for stock shipments to arrive in time for your installation.