Device Service Request Form - Digital Hand NW Skin Needling Device, Australian Clinics

Device Service Request Form - KausmediPen Corded (Digital Hand R) Skin Needling Device, Australian Clinics
Device Service Fee Structure

1. Device Assessment Fee

The first step in the device service process is an assessment to identify the cause of the issue and provide a quote for any necessary part replacements. The device assessment fee is $120 + GST and includes:
- All device service-related administrative tasks
  A comprehensive inspection to diagnose the issue
- Return postage for the clinic pen, including extra cover for loss or damage during transit
The assessment fee is payable at the bottom of this form. Please note that device service requests cannot be processed without upfront payment.

If our assessment determines that the device issue is due to a manufacturing defect or workmanship fault for which the repair should be fully covered under warranty, the assessment fee will be fully refunded.

2. Replacement Part Costs

After the device assessment, we will provide a quote for any necessary part replacements. If approved, payment will be processed using the card on which the assessment fee was paid.

If no part replacement is required, there will be no additional costs.

3. Loan Device Provision Cost

As an optional extra, you may request a loan device to use while we assess and repair yours which usually takes 6 ~ 8 weeks. The cost is $160 + GST and includes:
- Use of the loan device until the clinic device is returned
- All related admin work
- Postage to send a loan device to the clinic with extra cover for loss/damage during transit
- Prepaid satchel including extra cover for sending the clinic device to us for assessment and repair
- Prepaid satchel including extra cover for returning the loan device to us at the end of the service
- Quality check and maintenance of the loan device to ensure it is always in its top working condition.
This cost is payable at the bottom of this form. Please note loan device provision requests cannot be processed without upfront payment.

If our assessment determines that the clinic device issue is due to a manufacturing defect or workmanship fault for which repair should be fully covered under warranty, the payment received for the loan device will be fully refunded.
Do you accept the cost and wish to proceed?

Clinic name - Please include the branch location if applicable
Clinic phone number
Please enter a valid phone number.Format: (000) 000-0000.
Clinic address for delivery of the clinic device - If your clinic/salon is located in a large shopping mall, please include which level the clinic/salon is located and any other reference to prevent the parcel being delivered to another clinic in the centre.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any special delivery instructions

Name

First NameLast Name
Role/position in the clinic
Phone number

Area CodePhone Number
Email
example@example.com

Name

First NameLast Name
Role/position in the clinic
Phone number

Area CodePhone Number
Email
example@example.com

What is the serial number of the device?
*Please note we can only service a device with a valid serial number. *The serial number is engraved on the back of the pen on the silver metal part just below the plastic cap. *If the serial number cannot be found anywhere, please write 'cannot find'.
When was the device purchased?
If you cannot provide the exact date, please supply an approximate estimate or write 'not known'. In such cases, the warranty period will be determined based on our records of the first dispatch date from our warehouse.
Which company was the device purchased from?
Please note we can only service and/or repair the device which we (SB Australia Trading Pty Ltd trading as KausmediTech) supplied directly or through our authorised partners.
Please attach the proof of purchase if you have it available.

If it is not available at the moment, you can email it to us once you have it. Without proof of purchase, warranty eligibility will be determined based on our records.
Cancelof

Please describe in detail the issues you are experiencing with your device.
If you have any photos or videos that may help us understand the issues, feel free to upload the files below.

Cancelof
Please provide details of what you have tried to resolve the issues.

Loan Device Provision Request

As advised at the beginning of this form, a loan device can be provided for you to use while we assess and repair yours which usually takes 6 ~ 8 weeks. The cost is $160 + GST and includes:
- Use of the loan device until the clinic device is returned
- All related admin work
- Postage to send a loan device to the clinic with extra cover for loss/damage during transit
- Prepaid satchel including extra cover for sending the clinic device to us for assessment and repair
- Prepaid satchel including extra cover for returning the loan device to us at the end of the service
- Quality check and maintenance of the loan device to ensure it is always in its top working condition.
This cost is payable at the bottom of this form. Please note loan device provision requests cannot be processed without upfront payment.

If our assessment determines that the clinic device issue is due to a manufacturing defect or workmanship fault for which repair should be fully covered under warranty, the payment received for the loan device will be fully refunded.
Do you wish to request a loan device?

If you've requested a loan device, a prepaid Australia Post satchel will be sent with the loan device for the clinic pen. Please follow the instructions provided with the satchel to pack the clinic pen and kindly lodge the parcel at your nearest post office within 7 days of receiving the loan device. Is this how the clinic device will be sent to us?
If you have NOT request a loan device, you will need to post the clinic device to the address which will be emailed to you once we have reviewed your form submission. Is this how you will be sending your device to us?
If the prepaid return satchel we provided for the clinic device cannot be tracked at all for any reason and you have NOT provided proof of lodgement, we will be unable to make any claims with Australia Post in the event the parcel is lost or damaged during transit. In such cases, we cannot accept responsibility for the loss or damage of the clinic device. Do you agree to these terms?
We need to assess all the parts you have as the part/s can sometimes be the cause of the issue. Will you be sending us all the parts with the device?

After we assess your device, we will email you the assessment outcome and the cost of any part(s) required to be replaced. We kindly request you provide your response within a week from receiving the assessment report. Do you agree to do your best to provide approval within this time frame?
Any unreasonable delays in providing response may incur additional charges to cover the cost of extra follow ups as well as the cost of extended use of the loan device if one has been provided. Do you agree to this?
Once we have your approval, the approved additional part costs will be charged to the card used to pay the assessment fee. Do you agree to this?

You acknowledge and agree to us retaining your payment information to charge your payment card in the circumstances disclosed in this form.

Please choose the relevant fee/s and enter your card details for payment.

Device Assessment Fee - Digital Hand R

$120.00 AUD Quantity

Loan Device Provision Fee - Digital Hand R

$160.00 AUD Quantity

Subtotal

Tax

Total

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Device Service Request Form - KausmediPen Corded (Digital Hand R) Skin Needling Device, Australian Clinics

Payment

Please choose the relevant fee/s and enter your card details for payment.*

Please choose the relevant fee/s and enter your card details for payment.