Repair Request-Diatec Canada

Name

Province

Phone

Email

Instrument Model

Serial Number

Warranty Repair

Out of Warranty Repair

Power Cord

Insert Phones

TDH Headphones

Bone Conductor

Talk Back Mic

Monitoring Headset

Probe Assembly

Other

Details / Nature of Instrument Malfunction:

Perform annual calibration while unit is being serviced

I have included all transducers (Inserts, headphones, bone oscillators, etc) currently being used with the equipment

Shipping Type

Repair Request back