DIAG IM3 - Page 360

Veterinary Instrumentation Repair Request Form Please complete the details below. A good description of the fault will help us deal with your request accurately REMEMBER all items for repair must be clean and sterilised if possible before return. Please complete the decontamination certificate attached/overleaf. Account Number / Post Code Contact Name Office use only Practice Name Phone no Date rec Date sent Repair No C VI Staff member M Description of item returned for repair. Please include any serial number Y CM MY CY CMY K Description of fault Is a quotation required before repair? No Yes (PLEASE TICK) NOW PLEASE COMPLETE THE DECONTAMINATION CERTIFICATE ATTACHED/OVERLEAF PRIOR TO SUBMISSION OF REPAIR Issue 4 18-Mar-15 Page 1 " Repairs form (RP1) 344