• Red Light Therapy Rental Request

    Select your rental package and share delivery, purpose, and health details—your reservation is confirmed only after Strive Concierge reviews availability.

  • Choose Your Rental

  • Which rental experience would you like?*

  • Client Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred Contact Method*

  • Rental & Delivery Details

  • Preferred Rental Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Alternate Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Preferred Delivery Window*
  • Will stairs or access instructions affect delivery/setup?*

  • Purpose of Rental

  • What will you primarily be using red light therapy for?*
  • Surgery Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you already receiving Strive Concierge RN or CNA care?*

  • Health & Safety Screening

  • Wellness Disclaimer
  • Currently pregnant or possibly pregnant?*
  • Known photosensitivity disorder or unusual sensitivity to light?*
  • Taking medication that your physician or pharmacist said may cause photosensitivity?*
  • Active cancer diagnosis or currently receiving cancer treatment?*
  • Active skin infection, open wound, or condition in the proposed treatment area not cleared by your treating clinician?*
  • Advised by a physician not to use red or near-infrared light therapy?*

  • Rental Responsibility & Acknowledgments

  • I am interested in additional recovery support services

  • Signature

  • By signing below, I confirm that the information I provided is accurate to the best of my knowledge and that I have reviewed and agree to the acknowledgments above.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: