Medical Device Technical Support Request Form

Medical Device Technical Support Form Template

When medical devices malfunction or require technical support, every second counts—and every detail matters. This Medical Device Technical Support Request Form gives healthcare providers, medical device manufacturers, and clinical teams a fast, structured way to report device issues while maintaining full regulatory compliance.

Designed for medical device support workflows

This template is purpose-built for medical device companies, healthcare facilities, clinical engineers, and support teams who need to capture critical information quickly:

• Device identification including serial numbers, model numbers, and batch/lot information
• Detailed malfunction descriptions with context about when, where, and how the issue occurred
• Patient safety impact assessment to prioritize urgent cases and trigger appropriate response protocols
• Regulatory compliance section for tracking adverse events, MDR requirements, and quality system documentation

Whether you're managing post-market surveillance, handling customer complaints, or coordinating field actions, this form ensures nothing falls through the cracks.

Why medical device teams choose Paperform

For medical device manufacturers and distributors, Paperform offers the perfect balance of compliance-ready structure and user-friendly design. Your support form can match your brand while meeting the rigorous documentation standards required by FDA, ISO 13485, and international regulators.

Conditional logic lets you show or hide fields based on severity level—urgent safety issues can trigger additional questions about patient harm, while routine inquiries follow a simpler path. Automated notifications ensure the right team members are alerted immediately when a high-priority case comes in.

Streamline support with integrated workflows

Connect this form to your quality management system, CRM, or ticketing platform using Stepper, Paperform's AI-native workflow builder. Automatically:

• Create support tickets in your helpdesk or quality system
• Route cases to the appropriate technical specialists based on device type or severity
• Trigger adverse event reporting workflows when patient safety is involved
• Update compliance databases and maintain audit trails

With Stepper, every submission becomes a trackable case that moves through your support and regulatory processes without manual data entry or email chains.

This template helps medical device organizations deliver responsive, compliant technical support that protects patients, supports healthcare providers, and maintains regulatory standing—all from a single, professional form that works on any device.