Repair Order Send your equipment to Elite Dental Equipment Repair. 01 Your Information Tell us who we should contact about this repair. Practice name Contact name Email Phone 02 Shipping Address Where should we return the repaired equipment? Street address Suite / unit City State ZIP 03 Equipment For each item, choose Handpiece, Cavitron, or Other Equipment, then add repair details and photos. HANDPIECE Low Speed · High Speed · Electric CAVITRON Ultrasonic scaler repair OTHER EQUIPMENT Other dental equipment ITEM 1 · CHOOSE EQUIPMENT Edit Remove Brand * Model Serial number Handpiece type * Select handpiece type Low Speed High Speed Electric Problem type * Select a problem Describe the problem * PHOTOS AND VIDEOS Attach up to 10 photos and up to 3 video clips. Videos must be up to 20 seconds each. 0 / 10 Photos · 0 / 3 Videos UPLOAD MEDIA USE PHONE CAMERA Take Picture Record Video Scan the QR code with your phone to take photos or record videos. A private upload page will open on your phone. Open phone upload Add another item 04 ADDITIONAL NOTES Optional. Add anything else we should know before the repair. Additional notes 05 EQUIPMENT SAFETY CERTIFICATION Confirm the equipment was cleaned and disinfected before shipment. To help protect our technicians, all equipment sent to Elite Dental Equipment Repair must be cleaned and disinfected before shipment. Please follow the manufacturer’s recommended procedures for the equipment and any removable components. For ultrasonic scalers, please also ensure the internal waterlines have been properly treated before returning the unit. I confirm that the equipment has been properly cleaned and disinfected before being sent to Elite Dental Equipment Repair. Signature * Clear signature Printed Name * Date * 06 REPAIR AUTHORIZATION Please select your preferred repair authorization option. ESTIMATE BEFORE REPAIR Please inspect the equipment and contact me with an estimate before any repairs are performed. AUTHORIZE REPAIRS UP TO $449 I authorize Elite Dental Equipment Repair to perform non-warranty repairs up to $449, excluding shipping, handling, and applicable taxes. First-time clients: First-time clients will receive a repair estimate for approval before any repair work is performed. Returning clients: If the anticipated repair cost exceeds $449, Elite Dental Equipment Repair will contact you for approval before performing work above the authorized amount. Signature * Clear signature Printed Name * Date * 07 · SUBMIT REPAIR ORDER Ready to send your equipment? Review the information above, then submit your repair request. SUBMIT REPAIR REQUEST Secure repair request
ITEM 1 · CHOOSE EQUIPMENT Edit Remove Brand * Model Serial number Handpiece type * Select handpiece type Low Speed High Speed Electric Problem type * Select a problem Describe the problem * PHOTOS AND VIDEOS Attach up to 10 photos and up to 3 video clips. Videos must be up to 20 seconds each. 0 / 10 Photos · 0 / 3 Videos UPLOAD MEDIA USE PHONE CAMERA Take Picture Record Video Scan the QR code with your phone to take photos or record videos. A private upload page will open on your phone. Open phone upload
