templates/en/patient-resources-warranty-formulary.html.twig line 1

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  1. {% extends 'base.html.twig' %}
  3. {% block title %}Warranty formulary | CoaguChek{% endblock %}
  4. {% block description %}Fill out this form to validate the warranty on your CoaguChek INRange system.{% endblock %}
  6. {% block main %}
  7.     <section class="bg-patient text-white position-relative roche-header">
  8.         <div class="container-fluid">
  9.             <div class="row align-items-center">
  10.                 <div class="col-lg-4 offset-lg-2 py-5 px-0 order-2 order-lg-1">
  11.                     <div class="container">
  12.                         <div class="h1">CoaguChek<sup>®</sup> resources</div>
  13.                         <p class="mb-0">Find information about learning to use your CoaguChek<sup>®</sup> device, warranty, reimbursement, and the manuals for <span class="text-nowrap">CoaguChek<sup>®</sup> INRange</span> and <span class="text-nowrap">CoaguChek<sup>®</sup> XS.</span></p>
  14.                     </div>                    
  15.                 </div>
  16.                 <div class="col-lg-6 pe-0 order-1 order-lg-2">
  17.                     <img src="{{ asset('build/images/patient/06-Resources/00-Heroimage_1x.png') }}" srcset="{{ asset('build/images/patient/06-Resources/00-Heroimage_1x.png') }} 1x, {{ asset('build/images/patient/06-Resources/00-Heroimage_2x.png') }} 2x" alt="A man and woman sitting on a couch looking at a tablet" class="w-100" />
  18.                 </div>
  19.             </div>
  20.         </div>
  21.     </section>
  23.     <div >
  24.         <section class="position-relative roche-section__medium mb-0 pb-0 pt-3 roche-tab lb-tab-menu roche-tab__patient">
  25.             <div class="container lb-tab-container">
  26.                 <div class="nav d-flex rounded-4 shadow mt-5 py-3 justify-content-around">
  27.                     <a href="{{ path('patient-resources-self-testing') }}" class="nav-link">Self-testing</a>
  28.                     <a href="{{ path('patient-resources-warranty-formulary') }}" class="nav-link active">Warranty formulary</a>
  29.                     <a href="{{ path('patient-resources-reimbursement') }}" class="nav-link">Reimbursement</a>
  30.                     <a href="{{ path('patient-resources-device-manuals') }}" class="nav-link">Device manuals</a>
  31.                     <a href="{{ path('patient-resources-glossary') }}" class="nav-link">Glossary</a>
  32.                 </div>
  33.             </div>
  34.         </section>
  36.         <div class="tab-content">
  38.             <div class="tab-pane fade show active" id="warranty-formulary">
  39.                 {{ form_start(form) }}
  41.                 <section class="roche-section__medium">
  42.                     <div class="container">
  43.                         <h1 class="h2 text-patient">Warranty formulary</h1>
  44.                         <p>2-year warranty on CoaguChek<sup>®</sup> INRange manufactured by Roche Diagnostics </p>
  45.                         <p>To validate the 2-year warranty for your CoaguChek<sup>®</sup> INRange meter in Canada, complete and submit this warranty formulary.</p>
  46.                     </div>
  47.                 </section>
  49.                 <section class="roche-section__medium bg-soft">
  50.                     <div class="container">
  51.                         <h2>Your CoaguChek<sup>®</sup> INRange</h2>
  52.                         <p><small>Fields marked with * must be completed.</small></p>
  53.                         <div class="row">
  54.                             <div class="col-12 col-md-6 col-lg-3">
  55.                                 {{ form_row(form.serialNumber) }}
  56.                             </div>
  57.                             <div class="col-12 col-md-6 col-lg-3">
  58.                                 {{ form_row(form.dateOfPurchase) }}
  59.                             </div>
  60.                             <div class="col-12 col-md-6 col-lg-3">
  61.                                 {{ form_row(form.firstname) }}
  62.                             </div>
  63.                             <div class="col-12 col-md-6 col-lg-3">
  64.                                 {{ form_row(form.lastname) }}
  65.                             </div>
  66.                             <div class="col-12 col-md-6 col-lg-3">
  67.                                 {{ form_row(form.dateOfBirth) }}
  68.                             </div>
  69.                             <div class="col-12 col-md-6 col-lg-3" >
  70.                                 {{ form_row(form.inrSelfTesting) }}
  71.                                 {{ form_row(form.purpose, {'row_attr': {
  72.                                     'data-controller': 'dependent',
  73.                                     'data-dependent-source-value': '[name="warranty[inrSelfTesting]"]',
  74.                                     'data-dependent-active-value': 'no',
  75.                                 }}) }}
  76.                             </div>
  77.                             <div class="col-12 col-md-6 col-lg-3">
  78.                                 {{ form_row(form.healthcareProfessional) }}
  79.                                 {{ form_row(form.profession, {'row_attr': {
  80.                                     'data-controller': 'dependent',
  81.                                     'data-dependent-source-value': '[name="warranty[healthcareProfessional]"]',
  82.                                     'data-dependent-active-value': 'yes',
  83.                                 }}) }}
  84.                             </div>
  85.                         </div>
  86.                     </div>
  87.                 </section>
  89.                 <section class="roche-section__medium">
  90.                     <div class="container">
  91.                         <h2 class="text-patient">Contact</h2>
  92.                         <div class="row">
  93.                             <div class="col-12 col-md-6 col-lg-4">
  94.                                 {{ form_row(form.street) }}
  95.                             </div>
  96.                             <div class="col-12 col-md-6 col-lg-4">
  97.                                 {{ form_row(form.unit) }}
  98.                             </div>
  99.                             <div class="col-12 col-md-6 col-lg-4">
  100.                                 {{ form_row(form.city) }}
  101.                             </div>
  102.                             <div class="col-12 col-md-6 col-lg-3">
  103.                                 {{ form_row(form.postalCode) }}
  104.                             </div>
  105.                             <div class="col-12 col-md-6 col-lg-3">
  106.                                 {{ form_row(form.phone) }}
  107.                             </div>
  108.                             <div class="col-12 col-md-6 col-lg-3">
  109.                                 {{ form_row(form.email) }}
  110.                             </div>
  111.                             <div class="col-12 col-md-6 col-lg-3">
  112.                                 {{ form_row(form.language) }}
  113.                             </div>
  114.                         </div>
  116.                     </div>
  117.                 </section>
  119.                 <section class="roche-section__medium bg-soft">
  120.                     <div class="container">
  121.                         <h2 class="text-patient">Patient declarations</h2>
  122.                         {{ form_rest(form) }}
  123.                     </div>
  124.                 </section>
  126.                 <section class="roche-section__medium">
  127.                     <div class="container">
  128.                         <p>The CoaguChek<sup>®</sup> auto control system from Roche Diagnostics is guaranteed against all defects of functioning, manufacturing, or parts for a period of two years, beginning on the date of purchase. </p>
  129.                         <p>Liability under this warranty extends only to the repair or replacement of defective parts or materials or to the replacement of the system purchased to the exclusion of all other claims, demands, actions, and remedies even if the defect, damage, or loss has been caused by negligence or other fault of Roche Diagnostics.</p>
  130.                         <p>The warranty guarantees replacement of the system in the event of damage or any system malfunction that cannot be solved by means other than replacement of the components. This warranty replaces and supersedes any other warranty, whether expressed, implied, contractual, extra-contractual or statutory, respecting the named system, including but not limited to any implied warranty of fitness for a particular purpose.</p>
  131.                         <p>This warranty shall not apply to a Roche Diagnostics system not installed and/or used according to the instructions or specifications thereof, or to a Roche Diagnostics system damaged by accident or subjected to alteration, misuse, tampering, abuse, and/or repair or attempted repair by someone other than Roche Diagnostics or an authorized agent.</p>
  132.                         <p>In no event shall Roche Diagnostics be liable for any incidental, indirect, special, or consequential damages whatsoever, including but not limited to any personal or material damages or loss of use, revenue, or profit, even if the defect, damage, or loss is caused by the negligence or other fault of Roche Diagnostics.</p>
  133.                         <p>This warranty is granted only to the first purchaser for use of the system and is not transferable.</p>
  134.                         <p>The warranty is valid only if the name of the monitor and its serial number, date of purchase, and other requested information are entered on the attached Warranty card, which must be returned to Roche Diagnostics within thirty (30) days of purchase.</p>
  135.                         <p>The warranty period is not affected by any claim made under the warranty.</p>
  136.                         <p>If you have a claim under warranty, please call the following toll-free number: <a class="text-patient" href="tel:18774262482">1-877-426-2482</a></p>
  138.                         <button class="btn btn-patient text-white">{{ button_label|default('Submit') }}</button>
  139.                         
  140.                     </div>
  141.                 </section>
  142.     
  143.                 <section class="roche-section__medium bg-soft">
  144.                     <div class="container">
  145.                         <div class="row">
  146.                             <div class="col-lg-6">
  147.                                 <p>Roche Diagnostics <br>
  148.                                 Division of Hoffmann-La Roche Ltd <br>
  149.                                 201 Armand-Frappier Blvd. Laval, Quebec&nbsp;&nbsp;H7V 4A2 <br></p>
  150.                             </div>
  151.                             <div class="col-lg-6">
  152.                                 <p>CoaguChek<sup>®</sup> is a registered trademark of Roche <br>
  153.                                 © 2022 Roche Diagnostics. <br>
  154.                                 All rights reserved.</p>                        
  155.                             </div>
  156.                         </div>
  157.                     </div>
  158.                 </section>
  160.                 {{ form_end(form) }}
  161.             </div>
  163.         </div>
  165.     </div>
  168. {% endblock %}