Service Request

Service request information in advance of sending in your device

Service request information submitted in advance of sending in your device for service skips the line for fast and efficient processing.
Print a copy of your Service Request response email to include in with your device sent in for service. Feel free to add any additional notes or information to the printed email response when sending in your device for service.

Please submit your service request information in advance of sending in your device for service so that when your device is received, it is sent for processing fast and efficiently.

Avazzia device type*

* Indicates required field

What is the name of the Avazzia device to be sent in for service? *

Device Serial Number*

Check inside the battery compartment of the device. The serial number will be 16 digits long. *

Type of service requested. Description of what you would like repaired or done.*

Please include description for service to be able to reproduce reported problems to be serviced. Please include name of distributor or rep or anyone authorized to discuss this service request. *

Death or injury: Check One*

International medical device regulatory authorities require safety reported information for service requests. Please advise if the direct use of the device caused a death or serious permanent injury. *

Yes, there was a death or serious permanent injury requiring emergency or hospital care. No, there was not a death or serious permanent injury. Not Relevant

US FDA regulations require medical device owner name and contact information to be filed with medical device service repair records. This information may be reviewed by the US FDA upon request.

Full Name of owner of Avazzia device to be serviced: *

First

Last

Address of owner of Avazzia device to be serviced: US FDA regulations require medical device owner name and contact information to be filed with medical device service repair records. This information may be reviewed by the US FDA upon request. *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Date Device was Purchased *

Return Address if different from above *

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City

State

Zip Code

Country

Certification of truthfulness

Please Check For Certification *

Yes , I certify that the information provided is truthful to the best of my knowledge

Submit

Address for you to ship your device to once the above survey is complete:
Avazzia, Inc.
13140 Coit Road, Suite 515
Dallas, Texas 75240
USA
(T) 214-575-2820
(F) 214-575-2824
Business hours: 9:30am to 4:00pm, Monday through Friday