Requester information

All requests must be submitted at least 4 weeks before the requested date.

Requester name:

Supervisor name:

Email address:

I accept legal terms and privacy policy.

Request details

Requested operating room booking date:

Schedule / Duration:

Request type:

Study

Training

Organ harvesting

Model / product testing

Other

Procedure description:

Partner collaboration:

No

Yes

If yes, name:

If yes, email:

Funding:

IRCAD (quote submitted to Mr Marescaux)

Partner (quote submitted to partner)

Mixed (quote submitted to partner and Mr Marescaux)

Preferred operating room:

Baxter

Small operating room (tables 15, 16 and 17)

Large operating room

Number of tables:

Model type:

Pig

Cadaver

Pelvic

Organs

Other

Research project? Please complete the iCOMETH form

Number of models:

Specific needs to mention (sex, weight, ...):

Additional requirements

Equipment (e.g., C-Arm, Ultrasound, Scanner...):

Audiovisual (image, recording):

Scrub nurse required:

No

Yes

Catering:

No

Yes

Number of meals:

Additional information

You can upload attachments (jpg, jpeg, png, pdf):

Upload your file(s) here

Files submitted:

Do not forget to validate and send your request.

Validate and submit

New reservation

Your request has been taken into account.

A confirmation email has been sent to you.

Your request has been sent to us.
For any question: contact@ircad.fr.

IRCAD France