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!
Your Name or Main Contact
Address to Ship Items Back
Contact Phone Number
Approved PM/Repair Cost per Device (Service Only - Minimum Charge is $35)
PO # for Your Records (optional)
Category (Please fill out form again for each category. ie. rental return and service request require 2 separate RGA submissions)
Service (if you need a device repaired or P.M./ Re-certified )
Warranty (on serviced, repaired, or purchased pumps from Adepto)
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