Repair Form

* Indicates a required field

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Do you require a call from us?
- Yes Please
- No Thanks
Email*
Product Serial Number

If you have more than one product, enter all serial numbers here.
Please be as accurate as possible!
Description of the problem*
Description of equipment needing repair*

IMPORTANT: Please print this completed form and enclose within your return package.

Send the item(s) needing repair along with the completed repair form to:

HealthLight LLC
Repair Department
25 Hi-Tech Drive
Oglesby, IL 61348

We recommend using a service that will provide tracking. FedEx or UPS are the most reliable. If you don't have a box or packing material, you may go to a FedEx or UPS store and they can pack it up for you.

Repair Form

312-669-1053