Option 2 - Mattress Breakdown

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

Date

dd/mm/yyyy

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

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

Send me a copy of my responses