Repair Request Form

Thank you for trusting us to support your equipment repair needs.

The Repair Request Form should be included in the package with the equipment you are forwarding to Hospital Warehouse for repair. Please be sure to place a form in each box you are sending to us.

For your convenience there are two options below for completing and printing the Repair Request Form.


  • Option #1:.pdf of the form that you can open and print. The form would then be filled out by hand and included in the package.
  • Option #2:Word document that you can download, opened and completed on your computer and then printed. The form would then be included in the package.