Delivery and Installation Request - Johnson Health Tech Australia

Contact Information

On-Site Contact

First Name

Last Name

Contact Email

Contact Phone

Your Matrix Representative

Choose your Matrix Representative. This notifies your Matrix Representative once you have submitted the form

If you are not sure who your rep is, Select Sales

Facility Information

Is the site a business or residential site?

Business

Residential

Facility Name/Site Name

Is the site a new construction or existing facility?

New

Existing

Address

City

State/Province

Zip/Postal

Country

Facility Accessibility

What are the hours the site will be OPEN for delivery?

What are the hours the site will be CLOSE for delivery

Can your street accommodate and park a 10 tonne truck?

Yes

No

How close can a truck get to the delivery entrance?

Is there a loading dock?

Yes

No

If no, is there a commercial ramp and what are the dimensions of the ramp?

Is this a ground level delivery?

Yes

No

If no, how many stairs to the equipment room?

Is there a freight elevator available for delivery purposes?

Yes

No

N/A

If yes, what are the dimensions?

What is the width of the smallest stairway?

What is the width and height of the entry door(s)?

What are the width and height of the doors to the equipment room(s)?

What type of facility flooring will the equipment be placed on?

Electrical Information

Are there dedicated (non-looped ground) electrical outlets installed?

Yes

No

N/A

Do you have GPO Outlets installed?

Yes

No

Do you have Data Points installed?

Yes

No

How will you be connecting TV to your Cardio units?

CO-Ax

IPTV

MYE Receiver

No TV

Please be advised that customers are required to supply all data/antenna cables connecting to equipment

Does any equipment require re-location or removal?

Yes

No

Further details about the pre-existing equipment

Other Information

Is there anything unusual about your facility or location that could impede the installation?

Please attach any images you think may be relevant or assist with Delivery & Installation

Maximum file size: 10MB