Scientific Instrument Repair Center Online Request Form
Case Western Reserve University, William M. Frank - Director
Items marked with an * are required. Please enter a ? if unsure.
Please fill out this request form to the best of your ability. All equipment must be physically clean and
decontaminated
, with labels removed.
Be ready to provide a history of hazardous materials used, safety clearance, surveys, etc.
Contact Information
*First name:
*Last name:
*PI name:
*Full e-mail address:
Alternate First name:
Alternate Last name:
Alternate full e-mail address:
*Department:
Adolescent Health, Dept. of
Advancement of Medical Learning, Center for the
AIDS Clinical Trials Unit (ACTU)
AIDS Research, Center for
Anatomy, Department of
Anesthesiology and Perioperative Medicine, UH
Anesthesiology, Dept of - Cleveland Clinic
Anesthesiology, Dept of. - Metrohealth
Autonomic Laboratory
Bioarchitectonics, Center for
Biochemistry, Department of
Bioethics, Department of
Biomedical Engineering, Department of
Cancer Center, Case Comprehensive
Cardiovascular Research Institute
Case Center for Imaging Research
Case Center for Reducing Health Disparities
Clinical Investigation, Center for
Department not yet listed
Dermatology, Dept. of - UH
Design Fabrication Center
Emergency Medicine, Dept. of
Environmental Health Sciences, Department of
Epidemiology and Biostatistics, Department of
Family Medicine, Dept. of
Family Medicine, Dept. of - Metrohealth
General Clinical Research Center
Genetics, Department of
Global Health and Diseases, Center for
Health Care Research and Policy, Center for
Health Promotion Research, Center for
Heart and Vascular Research Center
John Carroll University
Medicine, Dept. of - Metrohealth
Medicine, Dept. of - UH
Metabolism Training Program
Metrohealth Medical Center
Modeling and Analysis of Physiological Systems
Molecular Biology and Microbiology, Department of
Molecular Medicine, Department of
Mouse Metabolic Phenotyping Center
Mt. Sinai Skills and Simulation Center
Neurogeriatrics, Laboratory of
Neurology, Dept. of - UH
Neurosciences, Department of
Neurosurgery, Dept. of - UH
Nutrition, Department of
Ophthalmology and Visual Sciences, Dept. of - UH
Orthopaedics, Dept. of - Metrohealth
Orthopaedics, Dept. of - UH
Otolaryngology - Head and Neck Surgery,Metrohealth
Otolaryngology - Head and Neck Surgery,UH
Pathology - Clinical - Metrohealth
Pathology - Clinical - UH
Pathology, Department of
Pediatric Pulmonology, Division of
Pediatrics, Dept. of - Cleveland Clinic
Pediatrics, Dept. of - Metrohealth
Pediatrics, Dept. of - UH
Pharmacology, Department of
Physical Medicine & Rehabilitation, Metrohealth
Physiology and Biophysics, Department of
Plastic Surgery, UH
Proteomics and Bioinformatiocs, Center for
Psychiatry, Dept. of - Metrohealth
Psychiatry, Dept. of - UH
Psychoanalytic Child Development, Center for
Radiation Oncology, Dept. of - UH
Radiology, Dept. of - Cleveland Clinic
Radiology, Dept. of - Metrohealth
Radiology, Dept. of - UH
Rammelkamp Center for Education and Research
Reproductive Biology (OB/GYN) - UH
Reproductive Endocrinology (OB/GYN) - Metrohealth
Research in Familiy Practice and Primary Care
RNA Molecular Biology, Center for
Science, Health and Society, Center for
Stem Cell and Regenerative Medicine, Center for
Structural Biology, Cleveland Center for
Study of Kidney Biology and Disease, Center for
Surgery, Dept. of - Cleveland Clinic
Surgery, Dept. of - Metrohealth
Surgery, Dept. of - UH
Swetland Center for Environmental Health
Translational Neurosciences, Center for
Tuberculosis Research Unit
Urology, Dept. of - UH
VA Hospital
If your department is not listed, please enter it here:
*Building:
*Room number:
*Phone:
*Speedtypes or PO number(PO minimum of $500):
Use the format: speedtype, percent to charge, speedtype, percent to charge, e.g. RES1234567,50%, RES456789,50%
Click here for instructions on obtaining a PO number using the Lawson System (opens a new window)
Equipment Information
*Equipment item:
*Manufacturer:
*Model:
*Serial number:
*Describe the problem:
Pressing the submit button will process your repair request and generate a confirmation number, and you should receive an email confirmation shortly.
System designed by
Mark F. Beno
(11/2009)
System designed by Mark F. Beno (11/2009)