Service, Warranty & Repair Form

The form below is to be used to submit service, warranty & repair requests only. Requests for quotes must be sent to  

Please note all fields are required. If you have questions, please contact or contact us by phone at 1-800-445-576. 

Hospital Name
Hospital Address
Billing Address
Same as Hospital Address
Contact Name
Contact Phone
Contact Email
Purchase Order Number**
Attach Purchase Order
Product Model/Item
Serial Number
Manufactured Date
Describe Malfunction/Event/Request
Is load testing Required?
Yes No
Has an adverse event occurred?
Yes No

**If a blanket purchase order cannot be provided, then please provide a purchase order for $800.00 for non-warranty repairs. Amendments can be made once the job is completed and quantified. Existing Hillrom customers on a service contract can quote their contract number instead of a PO number.

Warranty requests require a technician visit to verify the validity of the warranty claim. If a product no longer falls under the warranty, as per our warranty guidelines, you will be charged labour, travel, parts and any additional costs

Please note we will process your request within 24-48 hours on business days and follow up within five working days. If you have an existing Service Contract with Hillrom, the timescales will be those stipulated in your agreement. Incomplete information may result in an unspecified response time

I acknowledge Hillrom Australia Service, Warranty & Repair terms and conditions.