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Rentals
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10
Questions
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1
Choose DME
Select all equipment needed for the patient.
Hospital Bed
Wheelchair
Knee Walker/Scooter
Oxygen Concentrator
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2
Bed Extension
*
This field is required.
Add bed extension (recommended for patients over 6 ft tall)
YES
NO
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3
Hospital Bed Rail
*
This field is required.
Half Rail
Full Rail
Bariatric bed with Half Rail Only
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4
Matrass Type
*
This field is required.
Regular Matrass
Low Air Loss Mattrass
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5
Wheelchair Size
*
This field is required.
18" (W) x 16" (D) Max Weight: 250lb
20" (W) x 16" (D) Max Weight: 300lb
22" (W) x 16" (D) Max Weight: 500lb
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6
Oxygen Concentrator Type
Stationery
Portable
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7
Contact Information
First Name
Last Name
Please enter your phone
Please enter your email
User's Height
User's Weight
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8
Delivery Date
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9
Special Instructions (Optional)
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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10
Estimated Rental Total
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