Option 3 - Mattress Breakdown

Option 3 - Mattress Breakdown

Please fill all information in as much as possible.

Date*

Care Home Group.*

Please select your head office group name

Select or enter value

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*

Order Number

Please enter your order number (if required)

Preferred Mattress Type*

It is important you select the correct one. This information is usually written on the head end of the mattress cover.

Select or enter value

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

Document References CP67 / Document Version 1/ Date 13/03/2023/ Owned By Oskar Solvason / Approved by John Gerrard

Change History Document Version 1

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