Fix My Handpiece

Service Request Form

OUR PROCESS

– You explain the the type of handpiece(s) you are sending and the issue
– We send you a quote after our diagnosis
– You approve the price
– We fix the handpiece
– We send you the invoice
– You pay it
– We return the handpiece to you

Please sterilize all handpieces prior to pick-up.
FREE Pickup and Delivery:
In HRM with Minimum of 3 Handpieces

Outside HRM ship to:
Handpiece Doctor
168 Hobsons Lake Drive, Suite 301
Halifax, NS, B3S 0G4

Handpiece*
Handpiece Serial No. Problem Encountered

(Click the "+" sign to add additional handpieces)
Estimate Required*
- Yes
- No
Comments
Doctor's Name*
Phone*
Contact Name*
First Last
Email*
Address*
Street Address Address Line 2 City Province Postal Code
Phone
This field is for validation purposes and should be left unchanged.

(902) 488-6706

168 Hobsons Lake Drive, Suite 301, Halifax
Nova Scotia B3S 0G4

Handpiece	Serial No.	Problem Encountered