Get Straumann Guarantee Form Usa

Filling out the Straumann Guarantee Form USA online is an important process for individuals seeking product replacements under the Straumann Guarantee. This guide offers detailed instructions to help ensure a smooth completion of the form, enabling timely processing of requests.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Straumann Guarantee Form and open it in the editor.
2. Begin with 'Customer Information.' Provide your correspondence address, shipping address, account number, facility name, clinician name, contact phone, email, city, state/prov, and zip code. Ensure accuracy for efficient processing.
3. Next, move to 'Product Information.' Here, input the article (REF) number, lot/serial number, replacement device preference, placement date, event/removal date, and site (ADA). Ensure to indicate if you are replacing with the same device.
4. Fill out 'Patient Information' if applicable, particularly for implants. Include relevant allergies, medical history, patient ID (without using the patient's name), date of birth, gender, and smoking status.
5. In the 'Surgery Information - Implant Related' section, provide details regarding any surgical events, conditions, and the success of the procedure. Include details about implant conditions and relevant surgical factors.
6. For 'Event Information,' detail the assessment of implant hygiene and specify conditions that may have contributed to the event. Provide an explanation of why the event occurred.
7. Complete the 'Prosthesis Information' section by describing the type of restoration and when any failures occurred.
8. In the 'Instrument Information' section, provide details about the tools used during the procedure, including the type of cleaning and sterilization methods.
9. Confirm submission by either emailing the form, printing it for shipment, or both. Make sure to include all required information along with relevant documents.
10. Finally, sign the form to acknowledge understanding of the terms and conditions of the Straumann Guarantee. Ensure the signature is dated.

Complete your documents online today to ensure prompt handling of your Straumann Guarantee claims.