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Service Request Form

Use the form below to request ophthalmic equipment service, repair, or preventative maintenance for your optometry or ophthalmology practice. Our technicians provide professional service for a wide range of optometry exam equipment and diagnostic instruments, helping practices maintain accurate exams and minimize equipment downtime.

Whether you need equipment troubleshooting, preventative maintenance, calibration, or repair, our service team will review your request and contact your office to coordinate the next steps. We work with many types of ophthalmic diagnostic equipment, including phoroptors, slit lamps, autorefractors, lensometers, exam lanes, and other optometry exam room equipment.

Once your request is submitted, a member of our service team will follow up to gather any additional details and help schedule service based on your practice’s needs and location.

If your equipment is experiencing operational issues, requires routine maintenance, or needs professional evaluation, please complete the service request form below and our team will assist you promptly.

Service Request Form

Contact Information

Best Time to Contact
Morning
Afternoon
Anytime

Practice Location

Service location

Equipment Information

Equipment Type

Type of Service Requested

Service(s):

Service Description

Equipment Photos (Optional)

Upload photos of the equipment, error messages, or relevant documentation. Accepted file types: images and documents only.

Urgency Level

Urgency:
Low - Routine maintenance
Medium - Non-urgent repair
High - Affecting patient care
Emergency - Equipment not functional

Consent / Confirmation

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