Please complete this form and return with system

Download Form | * If form opens instead of download, to save right click the link and chose “download link as”

You will be emailed an RA number upon receipt of your system

Please ship this unit and completed form to:

Chattanooga Medical Supply Equipment Service

Warehouse 11608 Perpetual Drive

Odessa, FL 33556

Repairs can take up to 2-3 weeks. Sending a unit in is $55.00, which is waived if the unit is chosen to be repaired with our facility.