Device Service Request Form

Upon completion of this form, our After-Sales Service Department will contact you at the earliest opportunity to address and resolve the issue

Notice

Please submit the completed written request form on the laboratory’s official letterhead as an attachment.

If you have any questions or require further guidance, please contact us at +98 21 8860 7268 or reach out to the specialists of Ervin Danesh Azma Company through the Contact Us section

Name of the treatment center*
Applicant's first and last name*
Email address
National ID*
Economic code*
Mobile number*
Device name*
Serial number of the device*
Suggested date for service*
Form registration date*
Type of commitment*
- Has an annual service contract
- There is no service contract
- It is within the warranty period
- I don't know
Request type*
- Immediate service
- Service in six months
- Service in one year
Commitment form*
- Confirm
I undertake that this form is equivalent to a device service request with the center's seal and signature.
The reason for the request*
Attached
Accepted file types: jpg, png, jpeg, pdf, doc, docx.
Allowed extensions: jpg,png,jpeg,pdf,doc,docx
Name
This field is for validation purposes and should be left unchanged.