DEVICE REPAIR REQUEST FORM

Step 1: Dental Office & Contact Information - Step 1 of 3

Dental 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

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 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 option to ship your device to us

UPS Ground
USPS Ground

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 using your preferred carrier, please make sure to add insurance if you want to protect your sensor 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 Device Can’t be Repaired or Repair Is Declined:

A $125 Evaluation Fee applies to all unrepairable & evaluated devices (as a lot). This Fee is waived if any repair is successful and charged for. The Evaluation Fee covers the following: Evaluation of Device, Free Ground Return, & Attempted Repair.

Devices Not Claimed within 90 days will be discarded & Imagin is not responsible for them.

By Submitting 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.

DEVICE REPAIR REQUEST FORM

DEVICE REPAIR REQUEST FORM

Suggested Shipping Box Sizes — Use USPS or UPS

650-596-1001

Quick Links

Location Info

Connections