Oii NorCal Maintenance Request
There are multiple ways to fill out this form:
1. Open this form in an email on your iPhone or Android phone, fill it out and click SUBMIT
2. Open this form in your desktop email, fill it out and click SUBMIT
3. As a last resort print this email out, fill the form out manually and fax it back to 510-265-1395

PHOROPTOR NOTE: Phoroptor service takes between 6-8 weeks from the date we receive your phoroptor until you receive it back. This timeline is under normal circumstances and can be delayed due to volume, time of year, and holidays.

If you have any questions please feel free to call Oii at (510) 265-1389

IMPORTANT: If when you click on SUBMIT the form reappears on the screen it means you have not input all of the required information. If you do not have all of the information required please type in TBD and then click SUBMIT. When completed properly a message will appear on the screen letting you know the form was submitted.

Is this request *
If none of the above CHECK repair
Required
PRACTICE NAME *
Your answer
Practice Address *
Your answer
city *
Your answer
Phone Number *
Your answer
Point of Contact *
Your answer
Instrument Make or Brand *
if you select OTHER you MUST check the box
Required
Email *
an email is required for maintenance requests
Your answer
Instrument Type
if you select OTHER you MUST check the box
Instrument Model
Please be specific (for phoroptors please enter PLUS CYL or MINUS CYL in the space below)
Your answer
Instrument Serial Number
Please be specific
Your answer
Did you buy this from *
Required
Describe the problem as best you can
The more details the better. If you have multiple items please use the space below to list them
Your answer
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