Rental Form

🕒 DELIVERY HOURS

We deliver Monday–Friday, 6:00–8:00 PM, and Saturday–Sunday, 10:00 AM–5:30 PM. For hotels, delivery is usually the evening before check-in. For Airbnb stays, we’ll coordinate by text or email. National Mall and museum deliveries are available weekends only.
☀️ Peak Summer Travel Season

Summer is our busiest time of the year, and mobility scooters are in high demand. We will make every effort to provide the scooter model you requested. However, due to limited availability, we may substitute a comparable model with similar features to ensure you have mobility equipment for your trip.

We appreciate your understanding and recommend booking as early as possible to secure your preferred equipment.
Name

First NameLast Name
Company Name
Email
example@example.com
New Customer
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Equipment
Delivery Address and hotel name
Where are you staying
Reservation Under name
🏖️ Vacation Notice
Orthopaedic Mobility Rental will be closed for our annual vacation August 10–16, 2026. During this time, we will be unable to make deliveries, pickups, or accept new rentals.

We apologize for any inconvenience and appreciate your understanding. We look forward to serving you before or after our vacation.
Rental start

MonthDayYear
Date
Hour MinutesAM/PM Option
Rental end

MonthDayYear
Date
Hour MinutesAM/PM Option
User Full Name
Has the user used a scooter before
Type of mobility scooter 3 wheel or 4 wheels
Height
Weight
Where are you using the Mobility scooter or the Electric wheelchair
Are you transporting the scooter in a vehicle?
How did you here about us?
Additional Comments and questions
🛒 How to Order

1️⃣ Scroll down to see available equipment.2️⃣ Tap the box ✅ next to the item you want to rent.3️⃣ Choose your rental duration and quantity.4️⃣ Click “Pay Now” 💳 to complete your order.💡 Tip: You can select more than one item before checkout.

National Mall 1 Day Full Scooter Rental

Weight Capacity = 400lbs Drive Range =15-20 miles of travel per charge based on average use by a 175 LB person on a flat surface. Saturdays and Sundays only.

$150.00 Rental durationQuantity

Gogo Plus 3 or 4 Wheels Transportable Scooter Rental (Disassemble in 3 pieces)

Weight Capacity =300 lbs. Drive Range = 7-12 miles of travel per charge based on average use by a 125 LB person on a flat surface.

$150.00 Rental durationQuantity

Victory 10 Full scooter 3 or 4 wheels Rental

Weight Capacity = 400lbs Drive Range = 15-20 miles of travel per charge based on average use by a 175 LB person on a flat surface. Miles

$150.00 Rental durationQuantity

🛡️ Equipment Protection Plan (EPP) Optional

Protect your rental from accidental damage, loss, or theft during your rental period.✅ Covers: Small part replacements, theft (with a police report within 48 hours).⚙️ Deductible:• Scooters – $250 per incident• ✅ If you decline this plan, you’ll be fully responsible for repair, loss, or replacement costs during your rental.

$50.00 Quantity
Item subtotal:

📅 Cancellation Protection Plan (CPP)Optional

Add peace of mind to your reservation — protect your rental if plans change.✅ CPP Plus ($30): Full refund if canceled before delivery (minus CPP fee).✅ CPP Basic ($10): Partial refund if canceled 7+ days before delivery.🚫 No refunds after the scheduled delivery date. ✅ Fees are non-refundable and must be added before delivery.

$30.00 Quantity
Item subtotal:

Tip

Thank you so much for the tip. Orthopaedic Mobility Rentals

$5.00 TipTip

Enter coupon

Subtotal

Tax

Shipping

Total

Signature – By signing below you agree to the Orthopaedic Mobility Rentals terms and rental agreement.

Payment Methods

Debit or Credit Card

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🕒 DELIVERY HOURS

🛒 How to Order

Payment Methods