Customer Requests – True Spinal Decompression™

Customer Requests

For service calls, technical support, or machine move inquiries, please fill out the form below. We will be in touch as soon as possible.

Customer Request Form

"*" indicates required fields

Doctor's Name*

Contact Person's Name*

Request Type*

Serial Number 1*

Serial Number 2

Model Type*

Lumbar

Cervical

Are you currently enrolled in a service plan?*

Yes

No

Unsure

Are you currently able to treat patients?

Yes, machine is operational

No, machine is not operational

Email

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of Event*

What is 5 + 6?*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

4710 Eisenhower Blvd
Suite A-12
Tampa, FL 33634

1.813.210.1000

M-F 8:00 am – 5:00 pm