WI Medical Repair Service Request Form


Schedule Your Service Visit Here

Please fill out the form below. Once the form is submitted, a repair team member will call to confirm your repair appointment.

To complete the form, a credit or debit card payment will be required. WI Medical also partners with CareCredit for healthcare related purchases.
To apply for a CareCredit Heathcare Credit Card, please click here.


Fill out my online form.