Exchange & Return Authorization

Return & Exchange Authorization
This is a Return Authorization Request. Your return is not guaranteed until you have received the final return authorization form via email.

When returning a product, please note the following:
- Place product in a shipping box.
- Products must be returned in their original purchased form.
- All returns must be in a sale-able condition.
- Sterile products cannot be returned.
- Any returns after 30 days from invoice date are subject to approval.
- A 20% restocking fee may be applied for approved returns after 30 days.
- Special order items and/or items that are noted "non-returnable" may not be returned.
All questions with a red asterisk * must be completed before submitting the form.
Invoice Number
Date of Purchase

MonthDayYear
Doctor's Name*

First NameLast Name
Practice Name*
Name of Person Completing the return*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Choose type of transaction*

Return for creditReturn for exchange
Item to be Returned*
Reason for Return*
Return for exchange, please include the item you would like to exchange with the returned item. IF YOU SELECTED RETURN FOR CREDIT Please type NA in this field. *
A return shipping label can be provided for you out of convenience. However, it will be charged to your account. Return shipping fees are the customer's responsibility and are nonrefundable*

Include return shipping labelDO NOT include return shipping label
Returns that are accepted outside the 30 day return window may be subject to a 20% restocking fee.*

I understand and agree
Should be Empty:

Return & Exchange Authorization