REQUEST SERVICE

Medical Equipment Service When You Need It

Need equipment repair, preventive maintenance, an inspection, or troubleshooting? Tell us what you need and we’ll get in touch to coordinate service.

Southern California Based • Nationwide Travel Available • 24/7 Availability

REQUEST SERVICE

Submitting this form requests service and does not confirm an appointment. Charles Biomed will contact you to confirm availability and service details.

Medical Device Service Request

Please complete the form below to request medical equipment repair, calibration, inspection, or service from Charles Biomed.

Customer Information

Your Name *

Phone Number *

Email Address *

Please leave this field empty.

Contact Name / Phone — If Different

Facility / Service Location

Company / Facility Name *

Company / Facility Address *

Building

Floor

Department

Room

Office Hours

Best Time to Contact You

Medical Device Information

Device Type *

Manufacturer *

Model # *

Serial #

Service Details

Is the device currently in service?
YesNo

Is this device patient-care critical?
YesNo

Are there any error codes, alarms, or messages?

Preferred Service Date / Time

Service Description — Issue / Failure / Complaint *

The more information you provide, the better we can prepare for your service request.

Device Photos / Supporting Information

Once we receive your service request, Charles Biomed will email you to request photos of the equipment, including the device, model/serial-number label, error messages, or any other information needed to evaluate your request.

Service Request Notice:

Submitting this form is a request for service and does not by itself constitute a confirmed service appointment. Charles Biomed will review the information provided and contact you to discuss the request, scheduling, and any applicable service charges.

Requestor Authorization

Requestor Name / Title *

Date

Authorization *
I am authorized to request service for the facility listed above.

NEED HELP NOW?

Service Area

Southern California
Nationwide Travel Available

Availability

24 Hours a Day
7 Days a Week