Service Form

We provide the highest quality service so your equipment performs at its very best.
Please complete the Service Request Form below and our Service Team will be in contact with you to arrange the service or repair of your equipment.

For urgent service requests, please do not submit this form. Please ring the team directly on (02) 9714 1100.

For any other matters relating to service requests, you may contact our helpful Service Team on 1300 930 930 or email service@alphalifecare.com.au for more information.
Requestor/ Therapist Details*

First NameLast Name
Job TitleCompany Name
Phone Email
Client Details*

First NameLast Name
Primary Contact NumberSecondary Contact Number
EmailStreet Address
Funding Type*
Further Notes
Service Details*

Street AddressProduct Name/Code
Original Reference NumberSerial Number
Are there any known faults with the equipment?*

YesNo
NOTE: Where products are damaged, please upload photos of the equipment to be serviced, e.g. wheelchair, shower commode, etc. as well as the damaged area and broken parts. This will help speed up the service procedure. (Maximum of 3 images / Limit of 2Mb per file)
File Upload*

Cancelof
Access Considerations

There is space for parking.The building/residence has level access. e.g. no stairsThe hallways, doorways and corners are wide enough to maneuver large equipment.
Safety Considerations

The client requires carers/family to be present to safely receive the equipment.There are pets that Alpha Lifecare's technicians need to be wary of.
Special Instructions
Please verify that you are human*
Should be Empty:

We provide the highest quality service so your equipment performs at its very best.