Repair Request Form -- Call for Shipping Instructions

Please complete the following form with as much information as you have available, and one of our representatives will contact you to make arrangements for picking up or shipment of your damaged items to our nearest repair center.

Your Name:

Your Company:

Your Address:





Email Address:

Description of Equipment/Problem:

Special Surgery
Resources and Repair, Inc.
Corporate Headquarters
Baltimore, Maryland
Fax (443) 864-4063

Direct Sales
Dan Mason
Phone (443) 324-2232


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