Tech Support & Power Chair Repair Request Form

Please complete the short form below and we will contact you shortly!

When you first purchase a product from Bridge to Care USA, we do everything in our power to give you confidence in your purchase. Whether that’s through our 14-day risk-free trial or a financial plan, we want you to know, without a doubt, that the product you selected will work for you. However, if along the way you run into technical issues or need power chair repair services to some extent, we have our tech support here just in case. Once you give us an idea of what’s going on, we’ll work on figuring out the problem as well as the best course of action to remedy it. We understand that buying much of our equipment can become quite the investment—that’s why we strive to provide quality tech support and power chair repair services long after you’ve made your initial purchase.

Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Brand/Model Being Reported*
Did you purchase this unit from Bridge to Care?*
- Yes
- No
- Unsure
Serial Number*
Description of Problem*
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Personal Data Confirmation*
- YES, I ACKNOWLEDGE I HAVE READ THE PRIVACY POLICY AND AM FREELY SUBMITTING THIS FORM
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