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Phoroptor Maintenance Request Form

Use the form below to request professional phoroptor cleaning and preventative maintenance.

After submitting your request, a member of our service team will review the details and contact your practice to coordinate the cleaning process, including shipping or local service options and an estimated turnaround time.

To minimize disruption to your exam schedule, loaner phoroptors may be available during the service process. Based on your location, we may provide packaging materials and shipping labels, allowing you to easily send your phoroptor to us for cleaning and maintenance.

Simply complete the request form below and our team will follow up to coordinate the next steps.

Contact Information

Best Time to Contact
Morning
Afternoon
Anytime

Practice Location

Multi-line address

Phoroptor Information

Approximate Age of Unit
Under 5 years
5–10 years
10+ years
Unsure
Service Requested:
Preventative Maintenance + Cleaning + Calibration ($395)
Repair Evaluation (hourly rate)
Complete Overhaul ($790)
Phoroptor Condition:
Operating normally but due for cleaning
Slight stiffness or resistance
Lens rotation issues
Other mechanical issue

Loaner Phoroptor Request

Do you require a loaner phoroptor during cleaning?
Yes — our practice needs a loaner
No — we can send our unit without a replacement

A loaner fee of $25 will be applied to your final invoice.

Phoroptor Type
+cyl
- cyl

Based on your location, we may provide packaging and shipping labels to simplify the service process. Customer will be billed for any shipping expenses.

Additional Notes

Please include any additional details about the phoroptor or service request.

Consent / Confirmation

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