SRP Application

Please fill in the form and each of the fields with true and real data in order to proceed with the correct processing of the SRP, otherwise the request in the system will not be generated correctly.

Contact information – Step 1 of 2

Client's name *

First

Last

Name of esthetic center *

Customer contact phone number *

If possible, it should have WhatsApp.

Customer's e-mail address *

Address of the center where the equipment is located *

Address Line 1

City

State / Province / Region

Postal Code

Country

Name of authorized dealer or distributor *

Contact telephone number of the sales representative or authorized distributor *

Enter the cell phone number of your sales representative or distributor to facilitate pick-up and delivery if necessary.

E-mail address of sales representative or authorized distributor

Equipment with impact *

Serial number of the main equipment (Procyon, Protheus, Nexus, Hydravital…) *

If the serial number is not included in this form, the incident will not be attended. Example serial number: 3000057

Serial number of the defective equipment/accessory

If the accessory has a serial number (such as a hair removal hose), please enter that number so that we can fulfill your request.

Are you paying annual maintenance?

When did you purchase the equipment? *

What part of the equipment is failing or giving you trouble? *

defective problem e-mail

Error code or error message displayed

Examples: “COOLING_SYSTEM_THER_FAILED_1701155”, “HV_OUT_NOT_READY_FOR_TREATMENT”.

Detailed description of the incident *

Please describe IN DETAIL, what is wrong with the equipment. Failure to complete this field or provide sufficient information will result in the request being discarded.

Please include images of the problem

Click or drag files to this area to upload. You can upload up to 5 files.