Lake Court Medical Supplies, Inc.
Request for Return Merchandise Authorization
All requests for the return of merchandise are subject to evaluation and approval.
Reason for Return
Defective - New Out of the Box
Defective - in the Field
Make, Model, Color
If concentrator, how many hours on unit?
Date Picker Icon
Detailed Description of Reason being returned
PO or Invoice Number
Serial Number or Lot Number and Date of Manufacture (if applicable - enter NA for not Applicable)
If POC, please include sieve bed serial number.
Credit, Repair or Replacement
Who has the equipment - patient or dealer?
If applicable, patients height and weight?
Was patient in or using equipment when it broke/failed?
Was Patient injured/harmed when defect occurred?
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