KLASSIC HIP SYSTEM LOANER OR CONSIGNMENT REQUEST FORM

The request must be received no later than 2 p.m. MST two (2) business days prior to surgery. Requests received after 2 p.m. MST two (2) business days prior may be assessed a rush fee of $50

Loaner Kits must be returned within 48 hours after surgery. Extensions are available by submitting the Extension Request Form (FM-1505). A $150 charge will be assessed for Loaner Kits not returned within 48 hours. Additional fees may apply

1. Missing information may result in a delay of shipment.

2. TJO will confirm loaner availability and expected ship date via email. Confirmation will include the tracking number.

3. Upon receipt of product, verify that the order is complete and in good condition by checking received inventory against included Packing Slip. Customer is responsible to report any discrepancies immediately to TJO. If a discrepancy is not reported to TJO upon receipt of the kit, the customer will assume responsibility to replace any missing items. The Packing Slip must be signed and included when the set(s) is returned to TJO.

4. If the case is cancelled and the loaner instruments/implants are not used, the customer is still responsible to check to ensure all items are accounted for.

5. Loaner sets must be returned to TJO within 48 hours after surgery. Ensure that kit(s) are complete, packaged in designated containers, and ready for shipment. Customer must complete the Return Processing Form prior to returning the shipment. Loaner sets not received within 48 hours will be assessed a $150 late return fee.

6. Extension requests must be emailed ASAP to sales@tjoinc.com. Extensions must be received by TJO prior to 2 p.m. MST one (1) business day prior to expected loaner set return.

7. Report any damage to TJO immediately. Any lost or damaged product due to carrier negligence is the customer’s responsibility to file a claim.

IMPORTANT – PLEASE READ UPON RECEIPT:

Please verify the contents of the delivered kits using the Packing Slip. Confirm that all listed items are present. If any items are missing please notify TJO Sales Support immediately.

By signing below you are acknowledging receipt of all listed items, and will accept all responsibility for the proper care, use, and handling of these items while in your possession. Damaged or missing items will be billed to you. You will be billed for implants upon use.

The instruments listed above have been decontaminated. By signing below you agree that these instruments will be properly cleaned and safe to handle prior to return.