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 Included accessories Please check any accessories included with this Cavitron. Power Supply Water Line Foot Pedal Describe the problem * PHOTOS AND VIDEOS A picture or video of the equipment is required. If you cannot send a picture or video, please call or email us and we can assist you in submitting a work order. 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 ↓ Add a picture or video using the button below. 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. Add another item 04 ADDITIONAL NOTES Optional. Add anything else we should know before the repair. Additional notes 05 EQUIPMENT SAFETY CONFIRMATION 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. 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 * Printed name * Date signed Clear signature 07 · SUBMIT REPAIR ORDER Ready to send your equipment? Review the information above, then submit your repair request. I confirm the information in this repair request is accurate, the equipment has been cleaned and disinfected, and I authorize the repair option selected above. I could not capture or upload a photo/video because the camera, QR code, or upload failed. I understand I am submitting without media. 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 Included accessories Please check any accessories included with this Cavitron. Power Supply Water Line Foot Pedal Describe the problem * PHOTOS AND VIDEOS A picture or video of the equipment is required. If you cannot send a picture or video, please call or email us and we can assist you in submitting a work order. 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 ↓ Add a picture or video using the button below. 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.
