Return Authorization Form

Each device will need the information below:













If necessary, is there anyone else who may be contacted for additional information related to this event? Please provide their contact information below:



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Sigma Spectrum Infusion Pump is Rx Only

For the safe and proper use of the devices referenced within, refer to the complete Instructions for Use or the appropriate manual.
Please refer to manufacturer’s Package Insert for drug products mentioned herein for Full Prescribing Information.