Breast Pump Rental Inquiry form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
My home address is in:
Portland/Metro/SW Washington
Hood River County or Wasco County
Other
I am interested in renting a breast pump:
For a month or more ($65/month)
For 1-4 weeks ($25/week)
Double pumping kit ($37)
Unsure
We never want rental fees to impact your decision to rent a pump. If the cost of renting a breast pump presents financial hardship for your family, check the box below and we will reach out to you with options.
Check here
Submit
Should be Empty: