Thank you for using the Sirtex Online Order Form. Please complete the fields below to place your order. After your order has been processed, you will receive an order confirmation from Customer Service.

Cancellation Policy: If for any reason, your order of SIR-Spheres microspheres has to be cancelled, please contact Sirtex no later than 12 pm CET Thursday of the week before implantation is scheduled. Receipt of your cancellation will be confirmed by Sirtex.

If you have any questions, please email cs-eu@sirtex.com or call us on +49-228-1840-730.

SIR-Spheres® Y-90 resin microspheres Hospital Order Form




Delivery Information


Treatment Site Information



Distributor Information (if applicable)


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Order Information



Deadlines


Attention! The selected delivery date is prior to the first available delivery date: . Please modify the date or contact Customer Service for availability.


Quantity Item Number Item
SIR-Y001 SIR-Spheres Y-90 resin microspheres
(Standard Activity per Dose: 3 GBq +/- 10% at Calibration)
SIR-K002 Accessory Pack
(Delivery Set, V-Vial and V-Vial Holder)
Max. 4 packs per dose
SIR-S001 Syringe Shield
SIR-B001 Delivery Box
-
Other, please specify:








* mandatory field
SIR-Spheres® is a registered trademark of Sirtex SIR-Spheres Pty Ltd.

Form 904e
Reference: QSOP06
073-E-1218

Revision # 0 (CR 2449) Issued 21 Dec 2018

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