Installation Warranty Feedback Form for

CARESTREAM Image Suite

Vita CR System
Vita Flex CR System
DRX Core Detectors
PRO Detectors
TRIMAX Detectors

Confidential
Publication No. AF9754
2017-10-12
 Carestream Health Dealer
Installation Warranty Feedback Form

Warranty Statement
Carestream Health X-ray systems shall be warranted for a period of 12, 24, or 36 months from the original
installation, the date of which will be determined by a completed, returned warranty form. Please fax or e-mail
the form to Carestream Health (CSH) within 30 days of system installation. In no case shall the warranty exceed
30 days greater than the warranty period from the date of shipment. If the warranty form is not returned to CSH,
then the warranty period will begin on the date of product shipment (invoice date) and last for no more than 30
days greater than the warranty period. Dealer should complete only one (1) form per system or accessory.
Note: Please return within 48 hours of completing install.

Fax: 1-866-689-7341 (OR) E-mail: csh-dealer-install-feedback@carestream.com.

Dealer Information:
Dealer Name: _

P O Number (If Available): _

Service Rep Name: _

Phone: _

E-mail: _

End Customer Information:

Facility Name:

Street Address:

City:

State: Zip:

Contact Name:

Phone:

E-mail:

Equipment Location:

Publication No. AF9754 | 2017-10-12

Equipment Information:

Install
Equipment K# Serial # Date

Vita CR System/
Vita Flex CR System

Image Suite Console

Image Suite Software N/A

DRX Console

DRX Core Detector(s) N/A

TRIMAX Detector(s) N/A

PRO Detector(s) N/A

Publication No. AF9754 | 2017-10-12

Installation Questions:

1. What were the main concerns during installation? (Please circle all that apply and provide
specific details for each)

a. Assembly Defect - (ex. any loose components, welding, quality defects)

b. Damaged – (ex. Scratches, bent covers, etc.)

c. Defective – (ex. Component did not work)

d. Missing/ Wrong – (ex. Parts not on original order, parts not shipped, parts received
were incorrect)

e. Service Readiness Issues – (ex. configuration/setup problems)

f. Site Readiness Issues – (ex. site not ready for installation)

g. Transportation Issues – (ex. Delivery delays, packing/damage in delivery)

2. Additional Comments about the install: