Customer Support

We're here to help! Please fill out the form below and an OrthoGrid Representative will contact you within one business day to help get your facility back up and running.

OrthoGrid Service Ticket Form

Section 1 Device Information

SECTION FILLED OUT BY INDIVIDUAL SUBMITTING SERVICE TICKET
Reported By: *

First Last
Invalid value

Individual filling out the service ticket (Hospital Staff or OrthoGrid Internal).
Device Name: *

Invalid value

If PhantomMSK (digital), enter Device Name as: "2019XXXXX" located on the Asset Tag. If HipGrid Drone (analog) enter Device Name as "HipGrid Drone 9 or 12 inch and 40 or 45 degree".
Issue Description:

Invalid value

What occurred, what broke, any actions taken to correct.
Part Number Affected:

Invalid value

Part Numbers Listed below.
Calibration Array 9 inch - 1020-915-123
Calibration Array 12 inch - 1020-915-124
BNC / DVC Cable RA - 1020-916-119
Mouse - 1020-915-185
Keyboard - 1020-915-192
Teguar CPU - 1020-916-105
FSN Monitor - 1020-916-101
Power Strip- 1020-916-107
HipGrid Drone 9 inch 40 or 45 degree - 1015-009-125
HipGrid Drone 12 inch 40 or 45 degree - 1015-012-126
Serial Number or Lot Number:

Invalid value

Please list the Serial Number or Lot Number if available.
Within Warranty:
Invalid value
Replacement Part (RMA):
Invalid value
Date Service Requested

Invalid value

Please enter in the date by which replacement part is needed.
Section 2 Customer Information

SECTION FILLED OUT BY INDIVIDUAL SUBMITTING SERVICE TICKET
Facility Name: *

Invalid value

Input complete Facility Name.
Contact Name: *

First Last
Invalid value

Individual who will be receiving support.
Address:
Street Address Address Line 2 City State/Region/Province Postal / Zip Code Country
Invalid value

MANDATORY FIELD: Individuals address who will be receiving support and where the part, if needed, will be sent.
Phone: *
Number
Invalid value

Enter phone number to contact individual if more details are needed.
Was a Patient or User harmed or was there a potential for a Patient or User to be harmed? *
Yes - Describe below the harm that occurred or potential harm that could occur. No - Describe below why no harm possible.
Invalid value
Description

Invalid value

Describe harm or no harm.

Customer Support

OrthoGrid Service Ticket Form

Section 1 Device Information

Section 2 Customer Information