Equipment Repair Request
Please fill out your facility's details and list any equipment you would like our biomedical team to assess. This form does not guarantee a booking.
Name of person requesting service
*
First Name
Last Name
Clinic Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please list all of the equipment you would like us to service during your visit below:
Equipment Information:
*
If you haven't received one already, would you like us to provide a quote for service?
*
Yes
No
Please let us know if there are certain days of the week when your equipment will be out of use and available for service.
*
Please include any additional notes for our team regarding the equipment to be serviced:
*
If you have already described the issue in the previous field, please write N/A
Feel free to add any pictures or videos of equipment if needed.
Browse Files
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When you include photos or videos, it gives our biomedical team a clearer picture and helps minimize the need for a second visit.
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Please note that depending on the complexity of any issues we may discover during the service call, more than one service visit may be required to fully resolve the situation. While we strive to complete repairs on the first visit, we cannot guarantee that a fix will be permanent right away, as we work with delicate and intricate equipment. We carry a selection of universal and OEM parts on our service vans to help minimize the need for return visits. However, we are unable to stock every part for all machine types. If additional parts are needed from our warehouse or must be specially ordered, a follow-up service call fee will apply. If the machine passes all functional tests conducted by our biomedical team but the reported issue recurs, a service call fee will apply for each subsequent return visit as needed.
*
I acknowledge and accept the terms outlined above regarding service call requirements, parts availability, and additional fees for subsequent visits.
I am authorized to request the above services for the upcoming service visit.
*
I acknowledge
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