DEVICE REPAIR REQUEST FORM
Submit up to 5 devices at a time

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Step 1: Dentists Office & Contact Info - Step 1 of 3

Office or Practice / Company Name *

Doctor’s Name *

First

Last

We ask for this name to more easily find your repair ticket by doctor's name if you call us

Doctor Email *

Office Contact Person *

Same as Doctor Info
Separate Contact

Office Contact Person

First

Last

This office person will be our main point of contact instead of the doctor's name and email

Office Contact Email

This email will be used for all repair updates and communication.

Dentist Office Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Imagin provides a ground shipping label only for US-based addresses.

Office Phone Number *

Mobile Phone Number

Select a Dental Device Type ( Enter Up To 5 Devices Sequentially )

X-Ray Sensor Brands

3D Scanner Brands

Intraoral Camera Brands

Enter Brand

Device Serial Number

Write N/A if you cannot find a device serial number

Is this Device Still Under Warranty?

Select one or more device issues from the list below

Connection Issue – Disconnects when moved
Ready in software, doesn’t populate image when exposed
Unrecognized device error
Does nothing when plugged in – completely dead
Artifact / crack or dark spots in image
Auto-fires bad / static images
USB connector / plug broken
Cable issue: broken, exposed, split, creased
Cracked casing / shell
Cracked lens (3D scanners & IO cameras)
Other issue not listed

Description of Problem(s)

Please describe other problem(s) you are experiencing with your device

Accessories being shipped with your device:

USB Extension Cable
Software: Disc/Thumb drive
Laptop
Docking station

Check all that apply

Device’s Imaging Software

I.e. Eaglesoft, Dexis, VixWin, Apteryx (for X-Ray sensors)

ADD A 2ND DEVICE TO REPAIR

ADD A 2ND DEVICE TO REPAIR

Dental Device Type (Device 2)

X Ray Sensor Brands (Device 2)

3D Scanner Brands (Device 2)

Intraoral Camera Brands (Device 2)

Enter Brand (Device 2)

Device Serial Number (Device 2)

Write N/A if you cannot find a device serial number

Is this Device Still Under Warranty? (Device 2)

Select one or more device issues from the list (Device 2)

Connection Issue – Disconnects when moved
Ready in software, doesn’t populate image when exposed
Unrecognized device error
Does nothing when plugged in – completely dead
Artifact / crack or dark spots in image
Auto-fires bad / static images
USB connector / plug broken
Cable issue: broken, exposed, split, creased
Cracked casing / shell
Cracked lens (3D scanners & IO cameras)
Other issue not listed

Description of Problem(s) (Device 2)

Please describe other problem(s) you are experiencing with your device

Accessories being shipped with your device (Device 2):

Extension Cable
Software: Disc/Thumb drive
Laptop
Docking station

Check all that apply

Device’s Imaging Software (Device 2)

I.e. Eaglesoft, Dexis, VixWin, Apteryx (for X-Ray sensors)

ADD A 3RD DEVICE TO REPAIR

ADD A 3RD DEVICE TO REPAIR

Dental Device Type (Device 3)

X Ray Sensor Brands (Device 3)

3D Scanner Brands (Device 3)

Intraoral Camera Brands (Device 3)

Enter Brand (Device 3)

Device Serial Number (Device 3)

Write N/A if you cannot find a device serial number

Is this Device Still Under Warranty? (Device 3)

Select one or more device issues from the list (Device 3)

Connection Issue – Disconnects when moved
Ready in software, doesn’t populate image when exposed
Unrecognized device error
Does nothing when plugged in – completely dead
Artifact / crack or dark spots in image
Auto-fires bad / static images
USB connector / plug broken
Cable issue: broken, exposed, split, creased
Cracked casing / shell
Cracked lens (3D scanners & IO cameras)
Other issue not listed

Description of Problem(s) (Device 3)

Please describe other problem(s) you are experiencing with your device

Accessories being shipped with your device (Device 3):

Extension Cable
Software: Disc/Thumb drive
Laptop
Docking station

Check all that apply

Device’s Imaging Software (Device 3)

I.e. Eaglesoft, Dexis, VixWin, Apteryx (for X-Ray sensors)

ADD A 4TH DEVICE TO REPAIR

ADD A 4TH DEVICE TO REPAIR

Dental Device Type (Device 4)

X Ray Sensor Brands (Device 4)

3D Scanner Brands (Device 4)

Intraoral Camera Brands (Device 4)

Enter Brand (Device 4)

Device Serial Number (Device 4)

Write N/A if you cannot find a device serial number

Is this Device Still Under Warranty? (Device 4)

Select one or more device issues from the list (Device 4)

Connection Issue – Disconnects when moved
Ready in software, doesn’t populate image when exposed
Unrecognized device error
Does nothing when plugged in – completely dead
Artifact / crack or dark spots in image
Auto-fires bad / static images
USB connector / plug broken
Cable issue: broken, exposed, split, creased
Cracked casing / shell
Cracked lens (3D scanners & IO cameras)
Other issue not listed

Description of Problem(s) (Device 4)

Please describe other problem(s) you are experiencing with your device

Accessories being shipped with your device (Device 4):

Extension Cable
Software: Disc/Thumb drive
Laptop
Docking station

Check all that apply

Device’s Imaging Software (Device 4)

I.e. Eaglesoft, Dexis, VixWin, Apteryx (for X-Ray sensors)

ADD A 5TH DEVICE TO REPAIR

ADD A 5TH DEVICE TO REPAIR

Dental Device Type (Device 5)

X Ray Sensor Brands (Device 5)

3D Scanner Brands (Device 5)

Intraoral Camera Brands (Device 5)

Device Serial Number (Device 5)

Write N/A if you cannot find a device serial number

Enter Brand (Device 5)

Is this Device Still Under Warranty? (Device 5)

Select one or more device issues from the list (Device 5)

Connection Issue – Disconnects when moved
Ready in software, doesn’t populate image when exposed
Unrecognized device error
Does nothing when plugged in – completely dead
Artifact / crack or dark spots in image
Auto-fires bad / static images
USB connector / plug broken
Cable issue: broken, exposed, split, creased
Cracked casing / shell
Cracked lens (3D scanners & IO cameras)
Other issue not listed

Description of Problem(s) (Device 5)

Please describe other problem(s) you are experiencing with your device

Accessories being shipped with your device (Device 5):

Extension Cable
Software: Disc/Thumb drive
Laptop
Docking station

Check all that apply

Device’s Imaging Software (Device 5)

I.e. Eaglesoft, Dexis, VixWin, Apteryx (for X-Ray sensors)

Select a repair process option

Pre-Approved up to $1,000 Per Device Repair: Saves 1-2 days of time. We contact you if the repair costs more or device is non-repairable.
Quote-Based Repair: Typical 3-5 day repair time (excludes ship time).

2) Number 2)

Select a repair process option

Quote-Based Repair: Typical 3-5 day repair time (excludes ship time).

Select a Warranty Option for Repair

Standard 6-month Warranty ( Free ) – Parts and labor on the work Imagin does.
12-Month Extended Warranty ( +$495)

Select a shipping speed for us to return your repair order

2-Day (FREE)
1-Day (Price charged at invoicing)

Suggested Shipping Box Sizes — Use USPS or UPS

Priority Small Box

X-Ray sensors only

Priority Small Box
~5-1/2" x 1-3/4" x 8-5/8"

Priority Medium Box

X-Ray Sensor(s), & a 3D Scanner or Intraoral Camera

Priority Medium Box
~11-3/4" x 8-3/4" x 5-3/4"

Before Shipping Your Device:

Print the Submission Form from the Next Page, and Include it Inside your Package.

Carefully Package your Device to Prevent Damage in Transit.

Add Shipping Insurance to your Package to Avoid Lost Package Nightmares.

Shipping Responsibility:

You are responsible for shipping your device to us with your preferred carrier. Please be sure to add insurance if you want to protect your device in loss claims. Please keep track of your tracking number so you can track your package on its way to us.

Shipping From Outside The USA?

Reason For Export Must be: Repair & Return

Avoid Declaring Full Value (will trigger higher tariff fees)

Tariff Codes Available below:

Canada: 9813.00.0540

UK: 9813.00.05

If you don’t see a provided code Please contact your shipping carrier and find out your tariff codes needed to proceed.

If the device is unrepairable, a $125 evaluation fee will apply. Devices not claimed within 30 days will be discarded.

The evaluation fee covers the following: Evaluation of device, free ground return, & attempted repair.

By bubmitting this Form, I understand & agree to the terms and conditions of this repair contract.

Click the Submit Button Below - Please Do Not Click More Than Once.

Rating

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DEVICE REPAIR REQUEST FORM
Submit up to 5 devices at a time

DEVICE REPAIR REQUEST FORM

Submit up to 5 devices at a time

Suggested Shipping Box Sizes — Use USPS or UPS

650-596-1001

Quick Links

Location Info

Connections

DEVICE REPAIR REQUEST FORMSubmit up to 5 devices at a time

DEVICE REPAIR REQUEST FORM

Submit up to 5 devices at a time

Suggested Shipping Box Sizes — Use USPS or UPS

650-596-1001

Quick Links

Location Info

Connections

DEVICE REPAIR REQUEST FORM
Submit up to 5 devices at a time