TENS hire form

TENS Hire Form

My Birth Geelong
Full name*

First NameLast Name
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Email*
Phone number*
What is your estimated due date?*
Hire commencement date (from 37 weeks)*
How would you like to receive your TENS?*
Would you like to add a colostrum expressing kit to this order?*
Medium Kit- 8 syringes Large kit- 16 syringes
How did you find out about TENS hire through My Birth Geelong?
If you have any questions, please let me know
TENS hire fee is $90 for a 5 week period commencing from 37 weeks. You can opt for collection from Highton, or express postage (postage fee applies).

Everything in the TENS bag is to be returned, minus the white electrode pads, 2 batteries (single use only) and the fridge magnet- this is yours to keep. Return of the TENS can be via drop off, or postage back.

**Please wait for a confirmation email before making payment- just to ensure I have the TENS available when you need it (unless I have already confirmed availability for you).

If the hire is urgent you can always call me on 0414 918 114. Thank you!

PAYMENT DETAILS:

Bank Transfer-

Felicity Donaghy

BSB-083646 ACC-538570988

PayID- felicity@mybirthgeelong.com.au

PayPal- felicity@mybirthgeelong.com.au (credit card payments only)

Thank you for hiring from My Birth Geelong!
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TENS Hire Form