Option 2 - Mattress Breakdown

Option 2 - Mattress Breakdown

Please fill all information in as much as possible, only one entry per sheet please.

Date*

Name of the Care Home Group*

Advinia

Care Home Name*

Post Code*

Contact Name*

Please enter your name in case we need to contact you

Email*

We need this to send courier labels and updates

Telephone Number*

Mattress Make & Model*

Repair & Return*

If you would like this specific mattress returning, please select Yes. Please note, there is a 7-day turnaround from collection dependent on parts.

If you select No, you will receive an equivalent mattress.

Yes

Serial Number of Mattress*

Serial Number of Pump*

Please enter a brief discription of any faults with the mattress*

Plus any extra information we may need

Risk of Contamination If Any*

Is there any likely risk of contamination, such as COVID19 or MRSA

Boxed and Taped Up*

Is the Mattress & Pump Boxed and Taped Up?

Yes

Number of Boxes*

If the mattress & pump are not boxed and taped up, how many boxes do you need?

Document References CP64 / Document Version 1/ Date 13/03/2023/ Owned By Oskar Solvason / Approved by John Gerrard

Change History Document Version 1

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