Philips Healthcare Service Request Form

To book low and medium priority (non urgent) service requests online (such as preventative maintenance jobs), please complete the form below and one of our Customer Support Representatives will contact you within the next working day to confirm your request. Alternatively call on 1800 251 400 (Australia) or 0800 251 400 (NZ).
* Indicates required field.

PERSONAL INFORMATION
* First Name
*Last Name
*Hospital/Clinic
*Telephone
*Email

QUESTIONS

1. Alternative Contact Name

2. Alternative Contact Phone Number

3. Alternative Email

4. Priority
For all high priority calls, please contact the Customer Care Centre on 1800 251 400 (Australia) / 0800 251 400 (NZ).

5. Equipment number OR Serial Number

* 6. Request Type:*
Preventative Maintenance
Low Priority Corrective Maintenance
Field Change Order (FCO) Query
Information Required
General

* 7. Description of Fault / Service Request *

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