RETURN PROCESSING FORM

RETURN PROCESSING FORM
Shipping Date

MonthDayYear
Date
PRODUCT RETURNING
Type

ImplantInstrument
Kit #
RETURN CHECKLIST (INSTRUMENT)
Check if instrument kit not issued

Check if instrument kit not issued
Confirm and initial each line item below:
Verify instrument set is complete per included Stock Overview.
(initial above)
Verify instruments are free from damage.
(initial above)
Verify instruments have been properly cleaned for return and are safe to handle.
(initial above)
RETURN CHECKLIST (INSTRUMENT)
Check if implant kit not issued

Check if implant kit not issued
Verify unused implant boxes are free from any contaminants.
(initial above)
Verify boxes are not damaged or open.
(initial above)
Verify used implant sticker is applied to FM-1458.
(initial above)
By signing below you acknowledge responsibility and accuracy of each statement above.
Name (print)
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
TOTAL JOINT ORTHOPEDICS

MISSION-DRIVEN™

1567 East Stratford Ave.
Salt Lake City, Utah 84106
o. 888.890.0102 f. 801.486.6117 sales@tjoinc.com
Should be Empty:

PRODUCT RETURNING