PROVIDE BILLING/CONTACT INFORMATION
Date:
_________________________________________________________________
Henry Schein Account #:
________________________________
Name:
________________________________________________________________
P.O. #:
________________________________________________
Address:
_____________________________________________________________
State:
__________________
Zip Code:
___________________
Office Phone:
_________________________________________________________
Fax:
________________________________________________
Tech Code:
____________________________________________Int ernal Use Only
Work Order#
TOP - SEND WITH REPAIR (WHITE) BOTTOM - RETAIN FOR RECORDS (YELLOW)
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NOTE: Declined estimates are subject to a $11.99 Estimation Fee. International rates vary by location.
Submit your handpieces online www.prorepaironline.com or use this QR code
Have Feedback? Visit www.henryscheindental.com/prorepairfeedback and fill out the form.
Email:________________________________________________
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Make:
Serial Number:
Model :
Problem:
High-Speed Services
Premium Turbine Rebuild
o
Ceramic $169 (6 mo. warranty)
Premium Turbine Repair & Replacement
o o
Premier Authorized Turbine Manufacturer
o OEM Turbine Replacement
Low-Speed Services
Premium Repair & Replacement - Attachments & Heads
o Under $359
Premier Motor Overhaul
o
Under $609
Electric Services
Premium Repair & Overhaul
o Under $709
Additional Information
If a repair option is not selected, or more than one selection is made, the best value repair will be performed and charged.
Ceramic $ 339 (1 year warranty)
Steel $239 (6 mo. warranty)
2
SELECT RETURN DELIVERY SERVICE OPTION
3
o Second-Day Delivery (One handpiece) - $17.95
o
For t
hree
or more handpieces - No charge delivery
o Next Day Delivery - $24.95
If no response received within 7 days, the handpieces will be returned
unrepaired and a $11.99 evaluation fee will be charged per order.
Warranty Repair * Warranty information must be included *
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Make:
Serial Number:
Model :
Problem:
High-Speed Services
Premium Turbine Rebuild
o
Ceramic $169 (6 mo. warranty)
Premium Turbine Repair & Replacement
o o
Premier Authorized Turbine Manufacturer
o OEM Turbine Replacement
Low-Speed Services
Premium Repair & Replacement - Attachments & Heads
o Under $359
Premier Motor Overhaul
o
Under $609
Electric Services
Premium Repair & Overhaul
o Under $709
Additional Information
Ceramic $ 339 (1 year warranty) Steel $239 (6 mo. warranty)
Warranty Repair * Warranty information must be included *
H
A
N
D
P
I
E
C
E
Make:
Serial Number:
Model :
Problem:
High-Speed Services
Premium Turbine Rebuild
o
Ceramic $169 (6 mo. warranty)
Premium Turbine Repair & Replacement
o o
Premier Authorized Turbine Manufacturer
o OEM Turbine Replacement
Low-Speed Services
Premium Repair & Replacement - Attachments & Heads
o Under $359
Premier Motor Overhaul
o
Under $609
Electric Services
Premium Repair & Overhaul
o Under $709
Additional Information
Ceramic $ 339 (1 year warranty)
Steel $239 (6 mo. warranty)
Warranty Repair * Warranty information must be included *
Prices subject to change without notice. Other fees may apply.
Handpiece Repair Work Order
IMPORTANT All handpieces must be sterilized. INITIAL HERE TO CONFIRM Non-sterilized handpieces will be charged a $5.95 sterilization fee per handpiece.
If a repair option is not selected, or more than one selection is made, the best value repair will be performed and charged.
If a repair option is not selected, or more than one selection is made, the best value repair will be performed and charged.
To Submit Your Repair
Using This
Work Order Form:
1.
COLLECT
your handpieces. Use the
enclosed repair brochure to select your
repair option on the Work Order Form.
2.
PACK
and your sterilized handpieces in the
top copy of the Work Order Form
enclosed protective pouch.
3.
SEND us your handpieces. Affix the UPS
shipping label to the plastic pouch.
www.prorepair.com • prorepair@henryschein.com
One Brasseler Blvd
Savannah, GA 31419
1-800-367-3674 8am - 7pm EST
- Hand your package to a UPS Driver.
- Place in a UPS Drop Box
- Bring to a UPS Store
Remember to maintain your Handpiece!
Regular maintenance is critical.
If you need more information, please call
1-800-367-3674 to speak with our
Customer Care Team.
Scan, Submit & Save through the Portal
1. Scan the QR Code
2. Submit your repair
3. Save 10% on repair with code:
HPWO10
www.prorepaironline.com
Simple to use, full transparency
PROREPAIR HANDPIECE PORTAL
To Submit Your Repair
Online Use The:
