REPAIRS COLLECTION REQUEST

Repairs Collection Request Submission

CESI Instrument Repair Requisition Form

Requesters Details

Please provide your name, location and contact details

First Name

Last Name

Hospital / Trust Name

Phone/Mobile

Email

Repairs List

Please list all items for repair with any additional information

Items for Repair (To add the next item please push the + and it will add the next line

Qty

Description

Fault

Reference

Please upload any images that you think may be useful

Choose File

Collection Details

Please provide the address and any information that we will need to collect your repairs

Colection Department

Address

Address Line 1

Address Line 2

Town

County

Post Code

Country

Collection Contact Name

Collection Contact Phone Number

Number of Boxes / Packages

Additional Collection Details

Preferred Collection Date

Decontamination Declaration

I confirm that all instruments have been appropriately decontaminated and are safe to handle and transport.

Please upload decontamination certificate if available

Choose File

MORE INFO?

High Quality Surgical Instruments at very competitive prices
More than 16,000 items covering all surgical specialities
All popular patterns kept in stock for fast delivery

Need a reliable Surgical Instrument and Device repair service?
All repairs undertaken in-house reducing costs and turnaround times
Free National Collection and Delivery by friendly, experienced Area Reps

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