Book A Service | Paramount Dental Repairs

Repair Service Booking Form

Free Pickup and Delivery Available in an around Melbourne area. Mail-in options available.

Name of the Practice

Contact Name

Phone number

Mobile number

Email Address

Return Address

Suburb

State

Post Code

Please Select:

Repair Options

Please go ahead and repair Please Repair if under $300 per hand piece Please quote

Repair Options

Offer Code (Please give details) Warranty Claim (Please give details) Other (Please give details)

Details of the above Service Option

Decontamination Declaration:

I confirm that all items have been sterilised

Confirming Contact Name

Contant Signature

Date

Disassemble Confirmation

I acknowledge and agree that to provide a free quote all items will be disassembled for investigation and diagnosis.
If the repair quote isn't accepted items may be returned in disassembled state.

Make

Model

Serial Number

Fault

Make

Model

Serial Number

Fault

Make

Model

Serial Number

Fault

Make

Model

Serial Number

Fault

Repair Agreement

I agree to all the terms and conditions for quote and repair

Reply Paid 92230

Thomastown, VICTORIA 3074

0488 048 709

Call for Repair

Email Us

sales@paramountdentalrepairs.com.au