RGA Form (Returns Goods Authorization)
Please fill out this form each time you send a device to Adepto Medical for service/repair, warranty, and rental returns.
This form works great on your phone too!
Email address *
Company Name *
Your answer
Contact Name *
Your answer
Return Address Line 1 *
Your answer
Return Address Line 2
Your answer
Return Address City *
Your answer
Return Address State *
Return Address Zip Code *
Your answer
Do you need a FedEx return shipping label? *
Free for rentals returns, rental PM, and warranties. Please limit box to no more than 50 LBS and 24" x 24" x 24"
Contact Phone Number
Your answer
Approved PM/Repair Cost per Device (Service Only - Minimum Charge is $35)
Your answer
PO # for Your Records (optional)
Your answer
Category (Please fill out form again for each category. ie. rental return and service request require 2 separate RGA submissions) *
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