Backflow Testing & Repair Intake Form

Need annual backflow testing, repairs, rebuilds, or compliance service? Complete the intake form below to request residential or commercial backflow testing services in Arlington, Fort Worth, Dallas, and the DFW Mid-Cities area. Upload city notices, permit letters, or photos of the device if available.

Backflow Testing & Repair Intake Form

Please complete this form to request backflow testing, repair, rebuild, or compliance service.

Owner / Authorized Representative

Device Location

Commercial / Permit Information

Service Requested

Optional. Accepted files: JPG, PNG, PDF.

Authorization & Payment Terms

I authorize Hydrology Services to access the listed property location for the purpose of inspecting, testing, diagnosing, repairing, and/or servicing the backflow prevention assembly.

I understand that payment is due upon completion of services rendered unless other written terms have been agreed to in advance.

I further understand and agree that any unpaid balance not paid within ten (10) days from the date of invoice may be subject to a late payment charge of either $35.00 or 10% of the unpaid balance, whichever is greater, in addition to any reasonable collection costs permitted by Texas law.

Failure to provide access to the device, shutoff valves, or required utility information at the scheduled appointment may result in a service call fee.

Compliance Document Acknowledgment

I understand that the local water authority and the State of Texas may have deadlines regarding the submission of backflow testing and compliance documents.

I further understand and agree that compliance documents, test reports, or related submission paperwork may be withheld until the balance is paid in full unless other written payment arrangements have been made in advance.

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