• Citizens Pharmacy Medical Equipment Rental Agreement

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    Wheelchair 2 Month Rental Product Image
    Wheelchair 2 Month RentalAvailable in 16-, 18- and 20-inch sizes. All chairs include foot rests. Weighs 32-35lbs. 300 lbs. max capacity
    $120.00
      
    Knee Scooter 2 Month Rental Product Image
    Knee Scooter 2 Month RentalAvailable in black and pink. One handed braking systemIncludes wire basketWeighs 27 lbs.300 lbs. max capacity
    $120.00
      
    Rollator Walker  Monthly Rental  Product Image
    Rollator Walker Monthly Rental
    $90.00
      
    Total
    $0.00
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  • ADMINISTRATION

    For Pharmacy Use Only
  • Please click one of the PayPal options to complete payment and submit the form.

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