3DPrintViz Request

3DPrintViz Service Request
Request Submission Date (Today's Date)

MonthDayYear
Date
Your Contact, and Billing Information:
Name

First NameLast Name
Phone Number
E-mail
@ucdavis.edu email preferred, but not required
Department
PI Last Name
Processing Action
My Maximum Specified Budget ($)
We will only proceed if the estimated charge is less than this value. Else, we will contact you with a quote
How would you like to manage reimbursement for this project?
Patient MRN
Date of Surgery

MonthDayYear
Date
Account Manager Name
Please define a department contact who can help us with reimbursement for this effort
Account Manager Contact Email
example@example.com
Has your home-department pre-allocated funding for this effort?
Please only use this option in the event that this project extremely time-sensitive. Otherwise, please help us identify a point of contact within your department or an account. Thanks!
Aggie Enterprise Account Number, GL or PPM
Please Paste here. GL = 43 Digits, PPM = 29 Digits
I HAVE CONFIRMED THE ABOVE INFORMATION IS ACCURATE, TRUE, AND I'M READY TO CONTINUE
Service Details:
Requested Date of Completion

MonthDayYear
Date
Project Name
Please assign a name for this project. Please do not re-use project names.
Project Type

Other
Declared IRB Status
Please upload a copy of your IRB approval and protocol here:
IRB File Upload

Browse Files
Please use PDF file format Cancelof
General comments, and a basic description of your project:
Please provide any relevant information about your project - color, hardness, etc.
Service(s) in this request:

Other
Desired 3D printing technology
Client-provided manufacturing/processing details (optional):
Use this space to help us understand the important characteristics of your project. Examples might include color, opacity, stiffness, required materials, etc. We will discuss these details during a scheduled consultation
Ideal Appointment Times
Please provide multiple times, if possible.
File Upload (Optional)
Please upload relevant files below. If your file type of choice is rejected, please compress your file into a zip archive to permit the upload.
File Upload

Upload Files

Cancelof
Summary and Form Submission
Service Rates
- We operate with the following established rates:
  
  General Labor:
  
  Professional Staff Use: $125 for the first hour of professional staff time to include consultation, set-up, and design (minimum). $25/hour thereafter.
  
  Machine Use Time: $10/hour of machine operation. This fee covers materials, and machine use.
  
  Projects typically range in cost from $250 to $4500, depending on scope.
- Should be Empty:

3DPrintViz Service Request

Your Contact, and Billing Information:

Service Details:

File Upload (Optional)

Summary and Form Submission

Service Rates