X-Ray Film Purge Survey

Company:

Address:

City

State

ZIP

Storage Facility:

Contact

Phone:

Email:

Years of Stored Film:

Years of Film Available For Purge:

Date of Last Purge:

For Stored Film Only:

Available Film (Linear Feet):

or pounds:

Location of Film:
Onsite storageOff-Site Storage3rd Party Storage Vendor
Other:

Files Stored:
UnsortedSorted by yearSorted Alphabetically
Other:

Storage Fees: $
Potential Storage Fee Reduction: $

Would you prefer Barrington Medical’s full service staff to handle the sorting / purging (no
additional cost)?
YesNo

Would you prefer your facilities staff to handle the sorting and purging for film pick-up only?
YesNo

Barrel Program

Number of Barrels (Drums) that are onsite at your facility:

Length of time needed to fill those barrels:

Type of Film:

Previous Vendor Contact Name:

Phone Number:

Email:

Current Owner of Barrels Located Onsite:

When you have completed the form, please click the submit button.