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EVENTS

WOC 2012

World Ophthalmology Congress, Abu Dhabi, Feb. 16-20, 2012

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Last Update: 07.02.2012
Imprint

AMADEUS Public RMA Request Form

Owner: S & A   Version: 17.01.2008  

RMA# Request / Complaint Form

AMADEUS Support and Service > RMA Request
Please report your problem with the AMADEUS Microkeratome exactly according to this procedure (PDF)
Fields marked with * are mandatory

End consumer

Name:
* 
Contact Person:
* 
Address:
* 
City/ZIP:
* 
Country:
* 
Phone/Fax:
* 
E-Mail:
* 
Confirm E-Mail:
* 

Material

Original Warranty
Service Agreement
Control Unit s/n:
 
 
 Yes  No
 Yes  No
Motor Unit s/n:
 
 
 Yes  No
 Yes  No
Suction Unit s/n:
 
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
Blade Holder s/n:
 
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
Surface Holder s/n:
 
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No
Foot Pedal s/n:
 
 
 Yes  No
 Yes  No
Artificial Chamber s/n:
 
 
 Yes  No
 Yes  No
SurePass Blade Lot#:
 
 
 Yes  No
 Yes  No
SurePass Seperator Lot#:
 
 
 Yes  No
 Yes  No
Other
 
 
 Yes  No
 Yes  No
 
 Yes  No
 Yes  No

Notification type

Is this an RMA# Request and/or a Complaint and/or an Adverse Event ?
Has a patient been injured or was there a risk of injury?
 
 Yes  No
If yes, have the Regulatory Authorities been notified?
 
 Yes  No

Attach files

Problem description (Please describe your problem as exactly as possible)*
Ziemer Ophthalmics will contact you by phone or e-mail and will either:
  • provide recommendations that will help you solve the problem, or
  • ask you to return your product for inspection and / or repair. In this case, you will receive a Return Authorization Number (RMA#) and instructions for how to ship the unit.
Do not send any AMADEUS unit or accessories back to us without an RMA number