SERVICE CALL BOOKING REQUEST
Email : service.india@stryker.com Tollfree No : 1800 103 8030
Company / Hospital Details :
Name of the Company / Hospital:
*
Contact Name:
*
Contact Number:
*
Address:
Email Address:
*
State:
*
Select State
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
City:
*
Pincode:
Equipment Details :
Model
Unit Serial No
*
Contract Type
Action
Select Contract Type
Contract
Warranty
Ext-Warranty
Paid
Issue faced in the equipment :-
*
Event Date :
*
How was the issue noticed :
*
Was the case completed successfully :
*
Please select appropriate option
Not Reported
Yes
No
Complainant Not Aware
No Associated Procedure
Was medical intervention needed :
*
Please select appropriate option
Not Reported
Yes
No
Complainant Not Aware
No Associated Procedure
Was a patient involved :
*
Please select appropriate option
Not Reported
Yes - No Impact
No-No Impact
Complainant Not Aware
Yes - Impact - See Adverse Consequences
Was there a surgical delay :
*
Please select appropriate option
Not Reported
Yes
No
Complainant Not Aware
Were there adverse consequences ? :
*
Please select appropriate option
Not Reported
No
Complainant Not Aware
Patient
Patient and User
User
Submit
