Get Unitron Loss And Damage Form

The Unitron Loss And Damage Form is an essential document for reporting the loss or damage of devices. This guide provides a clear and detailed walkthrough on how to effectively complete the form online, ensuring that all necessary information is accurately recorded.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your online editing tool.
2. Start by entering your clinic contact information. Fill in the name, phone number, and email in their respective fields.
3. Proceed to the 'Bill to' and 'Ship to' sections. If they are the same, you can check the box indicating 'Same as Bill to'. Otherwise, ensure both account numbers are filled in correctly.
4. Under the 'Patient' section, ensure you provide the necessary patient details, including any relevant notes.
5. In the 'Devices' part of the form, enter the left and right serial numbers of the devices. If a replacement receiver is applicable, circle the appropriate option for either xS or xP.
6. Select the dome size required for the replacement device by choosing between open or closed, as well as the size — S, M, or L.
7. Indicate the power level, and specify whether the device was lost or damaged by checking the corresponding box.
8. Record the fee approval by entering initials, understanding that a non-refundable fee applies to all loss or damage claims.
9. If applicable, check the box indicating that a letter from the patient explaining the loss is included.
10. Complete the 'Details / special instructions' section with any additional information relevant to the claim.
11. Finally, enter the date and ensure all sections are filled out accurately before proceeding to save changes, download, print, or share the completed form.

Start filling out your Unitron Loss And Damage Form online today!