Fill this Online Form and Print It 
Please fill out this Repair Order Form for your handpieces. When you submit the form, it will take you to a printable page. Please print that page and include it with the handpiece you are sending us.

Blank Printable Order Form Option
If you prefer to print a blank order form and write into the fields, please click here for our blank order form.

Don't forget to print our Postage Free Mailing Label to attach to your package.

Required Fields *


***Please enclose no more than two handpieces in our postage free mail bags***

The following handpieces are enclosed.

Handpiece 1

Handpiece 2 (Optional)