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*

Complete my request so long as it's within my budgetComplete my request immediately without sending a quote (fastest)Send me a quote before proceeding (slowest)
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?*

This is a clinical case in the ORI'd like to specify a department contact who can take care of this on my behalfI'd like to specify an account, myselfI'm not sure, and would like to specify this in the future
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?

Yes, please coordinate with the above-defined account manager contactNo, I'd like to specify an accountI'm not sure
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*

True
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

ClincalResearchEducationDevelopmentOther
Declared IRB Status

IRB ObtainedIRB In-ProgressNo IRB, Not Required
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:*

Anatomical model for teaching/training purposesAnatomical model for diagnostic or pre-planning purposesAugmented or virtual reality (AR/VR) modelOther
Desired 3D printing technology*

Please help me decideStratasys Polyjet (VeroWhite, Tango+, TangoBlack+, MED610)Desktop FDM (PLA)Comercial FDM (ASA, ABS)Stereolithography, AKA SLA ("Clear", Dental Resin, etc)
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

Please click here to view our current recharge 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