Equipment Repair Ticket
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' Received. Thank you!
Please type your TICKET NUMBER here. Your ticket number is todays date and the last four digits of your practice phone number (YY-MMDD-####)*
Practice Name*
Contact Name*
Email*
Practice Phone Number*
Street Address*
City*
Postal Code*
Province*
Please Select
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland/Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
We highly recommend that you have a qualified service technician troubleshoot your equipment prior to sending it in for repair. Doing so can save you costly downtime by ensuring that your equipment does indeed need to be sent away for repair. Often issues can be solved quickly and inexpensively with remote troubleshooting.
My equipment has been assessed remotely by: *
Serona Animal Health
My equipment manufacturer (ie, iM3, Inovadent, etc.)
A third party repair technician
Name of service tech you spoke with*
Type of equipment needing repairs (ie. ultrasonic scaler)*
Make/model of equipment
Serial number of equipment*
Please attach image(s) of the equipment including any damage or specific areas of interest
Please include a detailed description of the problem*
I understand that my completed form will be emailed to me and that I must print 2 copies of my form results, one to include with my shipment and one for my records.*
Submit