Incident Repair and Exchange Service Return Form Downloads Arthroscopy ENT General Surgery Hysteroscopy Laparoscopy Medical Devices Micro Surgery Neuro Surgery Ophthalmology Orthopaedics Plastic and Aesthetic Surgery Spine Thoracic and Cardiovascular Surgery Urology RZ App FAQ´s Pay online Home >> Service >> Return Form Return Safety Form Introduction video Please fill in one form for each instrument you want to return. Step 1: Please attach the completed Product Return Safety Form to the outside of the returned package. Step 2: Ship to: RZ Medizintechnik GmbH / Unter Hasslen 20 / 78532 Tuttlingen To insure the safety of our employees, we deny the receipt of deliveries without necessary documentation or without proper decontamination of the products. Case number: Company Contact Person Email Address Article Number LOT-Number Additional markings on the product Invoice Number Date of invoice Reason for return ---RepairComplaintOther Other: Place of observation/default ---Receipt of goodsSterilization departmentDoctor *During surgery *Other * Other: * When and where did the defect occur? (name of hospital/ doctor etc.) Detailed description of the defect: Has the instrument been decontaminated? YesNo If “yes,” state a brief description of the procedure (Autoclave, Cidex, etc..): If “no”, the item will be returned! The above mentioned device is free of harmful substances or has been decontaminated according to the safety regulations. The data in this product return form has been entirely completed and is true. _____________________________ Date _____________________________________________________________ Signature Anti-Spam Question 2+3=? Form was sent successfully! Print now and attach it at the package.