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TacMed Simulation Repair Request Form

Please fill out all applicable fields. Once complete, select "Print to PDF" at the bottom of the form, save the document as a PDF, and email the completed form PDF back to customersupport@tacmedsolutions.com.

Customer Information

Organization:

Point of Contact:

Mr. Mrs. Ms.

Phone Number:

Email Address:

Military/Civilian Rank:

Shipping Instructions

Shipping Address:

Shipping Notes:

Product Information

Select the unit type of the relevant unit before continuing; the form will generate questions based on the unit type provided.

Unit Type: Serial Number:

Issue Details	Additional Information
Level 1 Issue: Level 2 Issue: Level 3 Issue:

Contact TacMed Simulation Support

First Name*

Last Name*

Email Address*

Phone Number*

Organization*

Item SKU*

Item Serial Number (e.g. HEMO-1234)

Reason

FSA/HSA cards accepted.

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TacMed Simulation Repair Request Form

Customer Information

Shipping Instructions

Product Information

Unit 1

Product Questions

Issue Reporting

Contact TacMed Simulation Support