Register Equipment for Warranty

Please complete this form when you set up your purchased equipment. Warranty will start from date of sale or date of submission of this form.

Contact Details

Patient Name: *

Clinician Name: *

Address of fitting

The address of where the patient was fitted for the equipment.

Address line 1: *

Address line 2:

Town / City: *

Post code: *

Date of fitting: *

Device Details

Stimulator type: *

Serial number: * Serial number can be found in the battery compartment.

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