Medical Device Software Field Correction Response Acknowledgement

I have read and understand the field correction instructions provided in the letter.*
- Yes
- No
Heidelberg Engineering Widefield Lens Serial Number*
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Primary Contact for Software Field Correction
(Please provide name, email and phone information)
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Agreement*
- I agree that Heidelberg Engineering GmbH may transfer this data solely for the purpose of responding to my contact inquiry to the distribution partner Heidelberg Engineering Inc.. Heidelberg Engineering Inc. is the fully owned subsidiary of Heidelberg Engineering GmbH in United States and processes data in compliance with local data protection laws and regulations. I confirm that I have read and accept the privacy policy. I understand that I can object to the use of my personal data with future effect at any time. I can address a revocation directly to the contact data stored in the privacy policy.
With * marked fields are obligatory.