{"id":1090,"date":"2026-09-14T15:03:13","date_gmt":"2026-09-14T19:03:13","guid":{"rendered":"https:\/\/medengs.com\/?page_id=1090"},"modified":"2026-09-15T08:05:25","modified_gmt":"2026-09-15T12:05:25","slug":"request-service","status":"publish","type":"page","link":"https:\/\/medengs.com\/?page_id=1090","title":{"rendered":"Request a Service"},"content":{"rendered":"\n<style>\n\/* Standalone form page: hide the whole site header (nav, white logo, Shop now)\n   and the theme's duplicate page title, so only the form remains. *\/\n.elementor-location-header,header.elementor-location-header{display:none !important}\n.page-header,.entry-header .entry-title,.ast-page-title{display:none !important}\n.mesr-wrap{--mesr-blue:#0B63B2;--mesr-ink:#2B3440;--mesr-mut:#6B7787;--mesr-line:#DDE3EA;--mesr-bg:#F5F8FB;\n  font-family:-apple-system,BlinkMacSystemFont,\"Segoe UI\",Roboto,Helvetica,Arial,sans-serif;\n  color:var(--mesr-ink);max-width:880px;margin:0 auto;padding:40px 16px 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a{color:var(--mesr-blue);text-decoration:none;font-weight:600}\n.mesr-alt a:hover{text-decoration:underline}\n@media (max-width:640px){.mesr-wrap{padding:26px 14px 40px}.mesr-grid{grid-template-columns:1fr}.mesr-card{padding:22px 18px}\n  .mesr-head h2{font-size:25px}.mesr-btn{width:100%}.mesr-foot{flex-direction:column;align-items:stretch}}\n<\/style>\n\n<div class=\"mesr-wrap\">\n  <div class=\"mesr-head\">\n    <a class=\"mesr-logo\" href=\"https:\/\/medengs.com\/\" aria-label=\"MedEngs home\"><img decoding=\"async\" src=\"https:\/\/shop.medengs.com\/wp-content\/uploads\/2024\/02\/Asset-1@3x-1.png\" alt=\"MedEngs\"><\/a>\n    <h1>Request a Service<\/h1>\n    <p>Tell us what needs attention and our technicians will get back to you to schedule a visit.<\/p>\n    <p class=\"mesr-allreq\">All fields are required.<\/p>\n  <\/div>\n\n  <div class=\"mesr-card\">\n    <div id=\"mesrMsg\" class=\"mesr-msg\"><\/div>\n\n    <form id=\"mesrForm\" novalidate>\n      <div class=\"mesr-sec\">\n        <h3><span>1<\/span> Clinic details<\/h3>\n        <div class=\"mesr-grid\">\n          <div class=\"mesr-f full\">\n            <label for=\"mesr-clinic\">Clinic \/ company name <i>*<\/i><\/label>\n            <input id=\"mesr-clinic\" name=\"clinic\" type=\"text\" autocomplete=\"organization\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-street\">Street address <i>*<\/i><\/label>\n            <input id=\"mesr-street\" name=\"street\" type=\"text\" autocomplete=\"street-address\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-city\">City <i>*<\/i><\/label>\n            <input id=\"mesr-city\" name=\"city\" type=\"text\" autocomplete=\"address-level2\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-province\">Province <i>*<\/i><\/label>\n            <select id=\"mesr-province\" name=\"province\">\n              <option value=\"Ontario\" selected>Ontario<\/option>\n              <option value=\"Quebec\">Quebec<\/option>\n              <option value=\"Alberta\">Alberta<\/option>\n              <option value=\"British Columbia\">British Columbia<\/option>\n              <option value=\"Manitoba\">Manitoba<\/option>\n              <option value=\"Saskatchewan\">Saskatchewan<\/option>\n              <option value=\"Nova Scotia\">Nova Scotia<\/option>\n              <option value=\"New Brunswick\">New Brunswick<\/option>\n              <option value=\"Newfoundland and Labrador\">Newfoundland and Labrador<\/option>\n              <option value=\"Prince Edward Island\">Prince Edward Island<\/option>\n              <option value=\"Northwest Territories\">Northwest Territories<\/option>\n              <option value=\"Nunavut\">Nunavut<\/option>\n              <option value=\"Yukon\">Yukon<\/option>\n            <\/select>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-postal\">Postal code <i>*<\/i><\/label>\n            <input id=\"mesr-postal\" name=\"postal\" type=\"text\" autocomplete=\"postal-code\" required>\n          <\/div>\n        <\/div>\n      <\/div>\n\n      <div class=\"mesr-sec\">\n        <h3><span>2<\/span> Contact person<\/h3>\n        <div class=\"mesr-grid\">\n          <div class=\"mesr-f\">\n            <label for=\"mesr-first\">First name <i>*<\/i><\/label>\n            <input id=\"mesr-first\" name=\"first_name\" type=\"text\" autocomplete=\"given-name\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-last\">Last name <i>*<\/i><\/label>\n            <input id=\"mesr-last\" name=\"last_name\" type=\"text\" autocomplete=\"family-name\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-phone\">Phone <i>*<\/i><\/label>\n            <input id=\"mesr-phone\" name=\"phone\" type=\"tel\" autocomplete=\"tel\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-email\">Email <i>*<\/i><\/label>\n            <input id=\"mesr-email\" name=\"email\" type=\"email\" autocomplete=\"email\" required>\n            <small>So we can send you the confirmation and report.<\/small>\n          <\/div>\n        <\/div>\n      <\/div>\n\n      <div class=\"mesr-sec\">\n        <h3><span>3<\/span> What needs service<\/h3>\n        <div class=\"mesr-grid\">\n          <div class=\"mesr-f\">\n            <label for=\"mesr-equipment\">Equipment \/ model <i>*<\/i><\/label>\n            <input id=\"mesr-equipment\" name=\"equipment\" type=\"text\" placeholder=\"e.g. Statim 5000, Sirona chair\" required>\n          <\/div>\n          <div class=\"mesr-f\">\n            <label for=\"mesr-urgency\">How urgent is it? <i>*<\/i><\/label>\n            <select id=\"mesr-urgency\" name=\"urgency\">\n              <option value=\"normal\" selected>Normal \u2014 schedule a visit<\/option>\n              <option value=\"urgent\">Urgent \u2014 equipment is down<\/option>\n            <\/select>\n          <\/div>\n          <div class=\"mesr-f full\">\n            <label for=\"mesr-details\">Describe the problem <i>*<\/i><\/label>\n            <textarea id=\"mesr-details\" name=\"details\" required\n              placeholder=\"What is happening, when it started, any error codes or noises.\"><\/textarea>\n          <\/div>\n        <\/div>\n      <\/div>\n\n      <div class=\"mesr-hp\">\n        <label for=\"mesr-website\">Leave this empty<\/label>\n        <input id=\"mesr-website\" name=\"website\" type=\"text\" tabindex=\"-1\" autocomplete=\"off\">\n      <\/div>\n\n      <div class=\"mesr-foot\">\n        <p class=\"mesr-note\">All fields are required. We usually reply the same business day.<\/p>\n        <button id=\"mesrBtn\" class=\"mesr-btn\" type=\"submit\">Send request<\/button>\n      <\/div>\n    <\/form>\n\n    <div id=\"mesrDone\" class=\"mesr-done\" style=\"display:none\">\n      <div class=\"tick\">&#10003;<\/div>\n      <h3>Request received<\/h3>\n      <p>Thank you. Our service team has your request and will contact you shortly to confirm a visit.<\/p>\n    <\/div>\n  <\/div>\n\n  <p class=\"mesr-alt\">Prefer to talk to us? Email <a href=\"mailto:info@medengs.com\">info@medengs.com<\/a><\/p>\n<\/div>\n\n<script>\n(function(){\n  var form = document.getElementById('mesrForm');\n  var btn  = document.getElementById('mesrBtn');\n  var msg  = document.getElementById('mesrMsg');\n  var done = document.getElementById('mesrDone');\n  var endpoint = '\/index.php?rest_route=\/medengs\/v1\/service-request';\n\n  function show(kind, text){\n    msg.className = 'mesr-msg ' + kind;\n    msg.textContent = text;\n    msg.scrollIntoView({behavior:'smooth', block:'center'});\n  }\n\n  form.addEventListener('submit', function(ev){\n    ev.preventDefault();\n    msg.className = 'mesr-msg';\n\n    var data = {};\n    var els = form.elements;\n    for (var i = 0; i !== els.length; i++){\n      var el = els[i];\n      if (el.name){ data[el.name] = el.value.trim(); }\n    }\n\n    var required = [['clinic','clinic \/ company name'],['street','street address'],['city','city'],\n                    ['province','province'],['postal','postal code'],\n                    ['first_name','first name'],['last_name','last name'],\n                    ['phone','phone number'],['email','email'],\n                    ['equipment','equipment \/ model'],['urgency','urgency'],\n                    ['details','problem description']];\n    var missing = [];\n    required.forEach(function(pair){\n      if (!data[pair[0]]){ missing.push(pair[1]); }\n    });\n    if (missing.length !== 0){\n      show('err', 'Please complete every field. Still missing: ' + missing.join(', ') + '.');\n      return;\n    }\n    if (!\/^[^@\\s]+@[^@\\s]+\\.[^@\\s]+$\/.test(data.email)){\n      show('err', 'Please enter a valid email address.');\n      return;\n    }\n\n    btn.disabled = true;\n    btn.textContent = 'Sending\u2026';\n\n    fetch(endpoint, {\n      method: 'POST',\n      headers: {'Content-Type':'application\/json'},\n      body: JSON.stringify(data)\n    }).then(function(res){\n      return res.json().then(function(body){ return {status: res.status, body: body}; });\n    }).then(function(out){\n      if (out.body.ok === true){\n        form.style.display = 'none';\n        msg.className = 'mesr-msg';\n        done.style.display = 'block';\n        done.scrollIntoView({behavior:'smooth', block:'center'});\n        return;\n      }\n      btn.disabled = false;\n      btn.textContent = 'Send request';\n      show('err', out.body.message || 'Sorry, something went wrong. Please call us or email info@medengs.com.');\n    }).catch(function(){\n      btn.disabled = false;\n      btn.textContent = 'Send request';\n      show('err', 'We could not send your request. Please email info@medengs.com and we will take care of it.');\n    });\n  });\n})();\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"<p>Request a Service Tell us what needs attention and our technicians will get back to you to schedule a visit. All fields are required. 1 Clinic details Clinic \/ company name * Street address * City * Province * OntarioQuebecAlbertaBritish ColumbiaManitobaSaskatchewanNova ScotiaNew BrunswickNewfoundland and LabradorPrince Edward IslandNorthwest TerritoriesNunavutYukon Postal code * 2 Contact person First [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1090","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/pages\/1090","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medengs.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1090"}],"version-history":[{"count":8,"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/pages\/1090\/revisions"}],"predecessor-version":[{"id":1106,"href":"https:\/\/medengs.com\/index.php?rest_route=\/wp\/v2\/pages\/1090\/revisions\/1106"}],"wp:attachment":[{"href":"https:\/\/medengs.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1090"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}