Biomedical Service Request Form…

Priority Levels

Priority Levels for Normal Working Hours
Monday through Friday, 8:00am to 4:30pm EST,
excluding Federal Holidays.

Low: Next Schedule Opening
Standard: 1-3 business days
Please Call 800.989.8949

For Emergency Service and After Hour Coverage
(Emergency Hours are 4:30pm-8:00am EST Weekdays,
all Weekend Hours and Federal Holidays)
Please Call 800.989.8949

Service Request

Full Name *

Company Name *

Email Address *

Confirm Email Address *

Direct Phone Number *

Description of Equipment *

Control ID (n/a if not applicable)

Make/Model

Serial Number

Issue Description (please provide as much information as possible) *

Location of Equipment *

Priority *

Low

Standard

In Case of Emergency or you require Same Day Service Please Call 800.989.8949

If you are human, leave this field blank.

Biomedical Service Request Form…

Priority Levels

About Us

Technical Life Care