NIC@HMS Request for Maintenance

Please fill out all of the following form. The NIC@HMS technician, Lara Petrak , will contact you ASAP to schedule an appointment.

First Name Last Name

Phone Number

Lab Building & Room Number

E-mail Address

Principal Investigator

Department

Your Position

33-Digit Billing Code - - - - - -

Affiliation(s)
Please check all that apply:

Harvard Medical School
Harvard Cambridge
Beth Israel Deaconess
Brigham & Women's
Children's Hospital
Dana Farber
Other

Where is your lab located?

What maintenance services are you interested in?

Mercury bulb replacement and alignment
Koehler illumination tutorial
Objective lens cleaning
Microscope cleaning
Diagnose problem with fluorescence
Diagnose problem with camera
Other

Please describe your problem:

Questions or Comments: