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Please complete the following form and return to .


CLIENT'S FULL NAME*
(NDIS participant's name)
Please enter Client's full name
CONTACT'S FULL NAME*
(Best person for technician to contact and arrange a time for the service)
Please enter Contact fulll name
CONTACT PHONE NUMBER*
(Best number for technician to call and arrange a time for the service)
Please enter Contact phone number
EMAIL ADDRESS*
(Where quote is to be sent)
Please enter a valid email
ADDRESS*
(Where the service will take place)
Please include your address
NDIS NUMBER
Please enter Ndis number
DATE OF BIRTH
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AUTHORITY TO CREATE THE NDIS SERVICE BOOKING*
(Please tick)
Please tick Authority to create the NDIS service booking
NDIS SUPPORT BUDGET FUNDS TO BE TAKEN FROM*
Please tick NDIS support budget funds to be taken from
PRODUCT NAME OF EQUIPMENT TO BE SERVICED/REPAIRED
Please enter Product name of equipment to be serviced/repaired
SERIAL NUMBER
Please enter Serial number
REASON FOR REPAIR*
Please enter Reason for repair
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)
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1300 131 884

 

About Us

Astris PME are Australia’s market leaders in assistive technology equipment for people of all ages and level of disability. We are dedicated to improving the lives of people by providing high quality products that are designed to promote independent and active lifestyles.

Accredited NDIS Provider 4050059296

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