MEDICARE TECHNICAL TICKET

Contact Person *

First

Last

Please enter the Reporter's Name and Surname

Email Address *

Please enter your email address where we can contact you.

Telephone number *

Please list your landline and mobile telephone numbers where we can contact you.

Company- / Entity- / Hospital Name *

Please enter the facility details.

Company- / Entity- / Hospital Address:

Physical Address for a call out if required.

Medicare Invoice Number (where applicable)

Please enter the original Medicare Invoice Number, or ProForma Invoice Number, or reference number for us to trace the original sale if you purchased this device with Medicare.

Type of Device or Medical Equipment *

Please let us know what device is this? Examples of devices we can service: Scales, Patient Monitors, CTG Monitors or -Capabilities, AEDs, Defibrillators, Wheelchair Repairs, Hospital Bed Repairs.

Make or Brand of the Device or Item

Please add the brand name if applicable; eg. Weinmann or Corpuls or Olive etc.

Model Name or Number

Please enter the Model Number or Model Name; eg. corpuls3 or OLV-5 etc.

Serial Number

For Medical Devices, we require a Serial Number.

Full Details of Request / Fault Report: *

Please include as much detail as possible. Please email us any video- or images of the fault, or let us know what action you would require?

Call Out required? *

Yes
No

We try to assess the damage using a video clip or photographic information provided. If you require a call out, we will send you a quote to come out and assess the issue.

Is this a warranty repair? *

Yes
No

Medicare usually offers a 12 month warranty on locally manufactured items or devices we import and supply - unless you have a specific longer warranty from us. This is 12 months from the original sale, and does not cover user damage or wear and tear. Please refer to our standard terms and conditions of sale for warranty terms of sale.

Would you require a service/repair quote for out of warranty repairs? *

Yes
No

If your device is out of warranty, or we did not supply it originally, we can quote you for the repair or service.

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MEDICARE TECHNICAL TICKET

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