Equipment Repair Request Form

We offer repairs on most medical equipment found in doctor's offices, clinics and surgery centers. These include, but are not limited to, diagnostic sets, EKGs, tables, lights, centrifuges, microscopes, sterilizers, warmers, patient monitors and stretchers.

Loaner equipment available
Electrical safety checks
Preventive maintenance
Sterilizer cleaning
Scale calibrations
Blood pressure calibrations
Equipment testing

Repair Request Form

All fields are required

Customer Name (account name)

Your Name

Your Phone Number

Your Email

Service Address (where we going)

Best Day & Time to Perform Service

Point of Contact When we Arrive

Make & Model of Equipment

Brief Description of Problem

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