MRN 3T Scan Credit Request Form
Please complete this request form to add scan credits to a funding PI Account for the MRN 3T MRI scanner. Scan credits are issued in 30 minute increments. Scan credits can be requested at any time during the month. Scan credits must be purchased before scheduling time on the 3T MR real time calendar. 3T credit requests will be filled daily by 10:00am in the order they were received. Any credit request made after 10:00am will not be added to your account until the next business day.

Scan credits expire 30 days after the effective date. You will be billed for all used and expired scan credits. In addition, MRI scans canceled within 72 hours or less of the scheduled time will be billed in full unless another project is able to use the reserved time.

Please enter your contact name and email address at the beginning of this request form. This information will be used to contact you if we have any questions about your request.

For questions about scan credits/billing, please contact Research Operations at ResearchOps@mrn.org
Email address *
Contact Name *
Please Enter Your Name: FirstName LastName
Your answer
Contact Email Address *
Please Enter Your Email Address
Your answer
Funding PI *
PI "bucket" the scan credits will be added to in COINS
Your answer
Scan Credits Requested *
This is the number of scan credits that the PI will be charged for (30 minutes = 1 scan credit).
Your answer
Scan Billing Code(s) *
Purchased scan credits can be applied to the following charge codes (list separately):
Your answer
Default Scan Billing Code *
This code will be used for any expired/unused scan credits.
Your answer
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