Kindly fill out the following information to submit a service exchange request for either a Stimpod NMS460 or a treatment probe.

First Name *

Last Name *

Email *

Cell Phone *

Date of Purchase

Issue Occuring With

Stimpod NMS460

Treatment Probe

Stimpod NMS460 Serial Number (this can be found behind the clip on the back)

Treatment Probe Serial Number (this can be found on white tape on the cord - if you do not have one, put N/A)

Video and or pictures of issue

Describe in detail any issues you are having with your device / probe

Shipping Address for Service Exchange Unit - Where would you like this unit sent?

Address

Shipping Address

City

State

Country

Postal code

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