Handpiece Rescue

2511 27th Ave

San Francisco, CA  94116


(415)753-8351 Fax


Please fill out this form and include with your handpieces.


Office Name and address: (Please print clearly)





Handpiece Make& Model                                                                        Serial Number                                                          (Circle one)

1                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

2                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

3                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

4                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

5                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

6                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

7                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

8                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

9                                                                                                                                                                    Just Repair        Receive Estimate first       Warranty

10                                                                                                                                                                  Just Repair        Receive Estimate first       Warranty

11                                                                                                                                                                  Just Repair        Receive Estimate first       Warranty

12                                                                                                                                                                  Just Repair        Receive Estimate first       Warranty


Print out form