Device Service Request Form - Digital Hand NW Skin Needling Device, Australian Clinics

Device Service Request Form - Digital Hand NW Skin Needling Device, New Zealand Clinics
Before completing the form below, please review our Troubleshooting Guide to determine if the issue can be resolved without requiring a service.

If you encounter any difficulties filling out the form or have questions, feel free to email us at service@kausmeditech.com.au or service@sb-australia.com.au for assistance.
Device Service Fee Structure

1. Device Assessment Fee

The first step in the device service process is an assessment to identify the cause of the issue and provide a quote for any necessary part replacements. The device assessment fee is $140 and includes:
- All device service-related administrative tasks
- A comprehensive inspection to diagnose the issue
- Courier fee for the clinic pen to be returned to the clinic
The assessment fee is payable at the bottom of this form. Please note that device service requests cannot be processed without upfront payment, except for LCNZ corporate clinics, which have a special arrangement to receive the invoice via email. LCNZ corporate clinics may submit the form without entering card details.

If our assessment determines that the device issue is due to a manufacturing defect or workmanship fault for which the repair should be fully covered under warranty, the assessment fee will be fully refunded.

2. Replacement Part Costs

After the device assessment, we will provide a quote for any necessary part replacements. If approved, LCNZ corporate clinics will receive an additional invoice for the part replacement. For all other clinics, payment will be processed using the card on which the assessment fee was paid.

If no part replacement is required, there will be no additional costs.

3. Loan Device Provision Cost

As an optional extra, you may request a loan device to use while we assess and repair yours which usually takes 6 ~ 8 weeks. The cost is $200 and includes:
- Use of the loan device until the clinic device is returned
- All related admin work
- Courier fee to send a loan device to the clinic
- Courier fee to collect your clinic device and deliver it to us for assessment and repair
- Courier fee to collect the loan device and return it to us at the end of the service
- Quality check and maintenance of the loan device to ensure it is always in its top working condition.
This cost is payable at the bottom of this form. Please note loan device provision requests cannot be processed without upfront payment, except for LCNZ corporate clinics, which have a special arrangement to receive the invoice via email. LCNZ corporate clinics may submit the form without entering card details.

If our assessment determines that the clinic device issue is due to a manufacturing defect or workmanship fault for which repair should be fully covered under warranty, the payment received for the loan device will be fully refunded.
Do you wish to proceed?*

Yes, I accept this cost and wish to proceed. - please fill out this form and provide the information we need to arrange your device to be assessed and repaired.No, I do not accept this cost and no longer wish to proceed. - sorry we are not able to assist further.

Clinic Details - Required
Clinic name - Please include the branch location*
Clinic phone number*
Please enter a valid phone number.
Clinic address - If your clinic/salon is located in a large shopping mall, please include which level the clinic/salon is located and any other reference to prevent the parcel being delivered to another clinic in the centre.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Primary Contact Details - Required
Name*

First NameLast Name
Role/position in the clinic*
Phone number*

Area CodePhone Number
Email*
example@example.com

Secondary Contact Details - Required
Name*

First NameLast Name
Role/position in the clinic*
Phone number*

Area CodePhone Number
Email*
example@example.com

Device Details - Required
What is the serial number of the device?*
*Please note we can only service a device with a valid serial number. *The serial number is engraved on the back of the pen on the silver metal part just below the white plastic cap. *If the serial number cannot be found anywhere, please write 'cannot find'.
When was the device purchased?*
If you cannot provide the exact date, please supply an approximate estimate or write 'not known'. In such cases, the warranty period will be determined based on our records of the first dispatch date.
Who was the device purchased from?*
Please note we can only service and/or repair the device which we (SB Australia Trading Pty Ltd trading as KausmediTech) supplied directly or through our authorised partners.
Please attach the proof of purchase if you have it available.

If it is not available at the moment, you can email it to us once you have it. Without proof of purchase, warranty eligibility will be determined based on our records.
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Details of the Issues - Required
Please describe in detail the issues you are experiencing with your device.*
If you have Please any photos or videos that may help us understand the issues, feel free to upload the files below.

Cancelof
Please provide details of what you have tried to resolve the issues.*
If you have not done already, we kindly urge you to review our troubleshooting guide on our website (https://kausmeditech.com.au/pages/digital-hand-nw-support)

Loan Device Provision Request - Required
Loan Device Provision Request

As advised at the beginning of this form, a loan device can be provided for you to use while we assess and repair yours which usually takes 6 ~ 8 weeks. The cost is $200 and includes:
- Use of the loan device until the clinic device is returned
- All related admin work
- Courier fee to send a loan device to the clinic
- Courier fee to collect your clinic device and deliver it to us for assessment and repair
- Courier fee to collect the loan device and return it to us at the end of the service
- Quality check and maintenance of the loan device to ensure it is always in its top working condition.
This cost is payable at the bottom of this form. Please note loan device provision requests cannot be processed without upfront payment, except for LCNZ corporate clinics, which have a special arrangement to receive the invoice via email. LCNZ corporate clinics may submit the form without entering card details.

If our assessment determines that the clinic device issue is due to a manufacturing defect or workmanship fault for which repair should be fully covered under warranty, the payment received for the loan device will be fully refunded.
Do you wish to request a loan device?*

Yes, I do.No, I do not require a loan device.

Sending Clinic Device in for Assessment - Required
If you've requested a loan device, a prepaid FedEx satchel will be sent with the loan device. Please follow the instructions sent with the satchel to pack the clinic pen and kindly prepare it for collection. Is this how the clinic device will be sent to us?*

Yes, I have requested a loan device and will use the prepaid satchel I receive with the loan device to send the clinic device to you.No, I have not requested a loan device.
If you have not requested a loan device, you will need to post the clinic device to us within 7 days of submitting this form. The address will be emailed to you after we have reviewed your form submission and you will also need to share the tracking details with us so we can monitor the parcel movement on our end and look out for the delivery. Is this how you will be sending your device to us?*

Yes, I will post the clinic device to you and assume full responsibility for any loss/damage during transit unless I choose to purchase an additional cover. I will also share the tracking details with you.No, I have requested a loan device and will use the prepaid satchel I receive with the loan device to send the clinic device to you.
We need to assess all the parts you have for the device with the device as the part/s can sometimes be the cause of the issue. Will you send us all the parts with the device?*

Yes, I have all the parts and will send them with the device.I have lost some parts, but will send what I have.No, I will not be sending any parts with it as I am certain the device is the issue. I understand if the assessment cannot confirm the reported issue with the device, I may need to eventually send in the parts and that additional assessment of the parts will be an extra charge.

Part Cost Approval - Required
After we assess your device, we will email you the assessment outcome and the cost of any part(s) required to be replaced. We kindly request you provide your response within a week from receiving the assessment report. Do you agree to do your best to provide approval within this time frame?*

Yes.No, I do not agree and no longer wish to proceed with this service request.
Any unreasonable delays in providing response may incur additional charges to cover the cost of extra follow ups as well as the cost of extended use of the loan device if one has been provided. Do you agree to this?*

Yes.No, I do not agree and do not wish to proceed with this service request
Once we have your approval, the approved additional part costs will be charged to the card used to pay the assessment fee or invoiced if you are an LCNZ corporate clinic. Do you agree to this?*

Yes.No, I do not agree and do not wish to proceed with this service request

Payment - Required (LCNZ Corporate Clinics must to answer the first question in this section)
Payment

Payment is required before we can process your service and loan device provision request.
Are you a LCNZ Corporate Clinic?*

Yes - please scroll down to the bottom of the page to submit the form and we will email you the invoice.No - payment is required for us to initiate your device service request. Please answer the question below and proceed with payment.
You acknowledge and agree to us retaining your payment information to charge your payment card in the circumstances disclosed in this form.

Yes.No, I do not agree and no longer wish to proceed.

Please choose the relevant fee/s and enter your card details for payment.

Device Assessment Fee - NZ

$140.00AUD Quantity

Loan Device Provision Fee - NZ

$200.00AUD Quantity

Subtotal

$0.00AUD

Tax

$0.00AUD

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Device Service Request Form - Digital Hand NW Skin Needling Device, New Zealand Clinics

Payment