Repair Request

Please fill out the information below and Sylvan will assist you accordingly. Call 1.800.628.3836 (724.864.9350) or email info@sylvanmed.com if you have any further questions.

Repair Request Form

Contact Information

Name *
Hospital Name *(Or parent company)
Department *
End Use Department *(NICU, Pediatrics, Emergency Room, Phlebotomy Team, Transport, etc...)
Phone *
Email *
End Use Department Contact Name (Or secondary contact in the hospital system.)
End Use Contact Email (Or secondary contact in the hospital system.)
End Use Contact Phone Number (Or secondary contact in the hospital system.)
Shipping Address
Direct shipping address for return shipment.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Shipping Address Notes Please note any specific attention lines, departments, floors, room numbers, etc...
Purchase Order Number (if available)

Transilluminator Repair Information

Transilluminator Model *Select the transilluminator model to be evaluated. If sending multiple units, please email us for more information.
Serial Number *
Description of Issues *
(For example: not turning on; low light output; dropped/broken; battery not charging; error code on battery charger)
NOTICE: Lithium Ion Batteries Lithium Ion Batteries: (for the Neoscan Neo2-W Only) Do not send any lithium-ion batteries back to Sylvan Fiberoptics for evaluation.
Fiberoptic Cables *Will fiberoptic cables (P101, N103, N103-90) be sent in with the device to be evaluated?
Battery Chargers *Will battery chargers (P106, K913, N220) be sent in with the device to be evaluated?
Hospital Labels / Trackers Are there hospital labels and / or tracking devices attached to the device or its accessories? If so, please note the number and location.
Additional Information

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Repair Request PDF

Repair Request

Repair Request

Repair Request Form

Contact Information

Transilluminator Repair Information

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