Thor Low Level Laser Therapy systems

Online Service Booking Form

Please use this form to book your system in for servicing. Go here to learn more about THOR's Maintenance and Repairs programme.

Prefix
First Name:	*
Last Name:	*
Email Address	*
Company / Hospital / Institution	*
Department
Profession	*
Address	*
City	*
Postal Code / Zip	*
State	*
Country	*
Home Phone
Work Phone	*
Cell / Mobile
Fax



Model Number	* how to find the model number
Serial Number	Drive Unit * how to find the serial number on the drive unit
	Probe 1 * how to find the serial number on the probe
	Probe 2
	Probe 3
	Probe 4
From which supplier did you purchase your THOR laser system ?	*
Purchase Date	*
Desired Collection Date	[must advise at least 2 working days prior to pickup]
Any known Faults?



Billing address [if different from above]
Title
First & Last Name:
Address
City
Postal Code
State
Country




	* required fields