General Online Request Form

Location being requested (Choose up to 2)*

Kanata Store - Hazeldean Mall - 300 Eagleson RoadBarrhaven - 16 Green StreetDowntown - 267 O'Connor StreetGlouceste - 1756 Montreal Road (Coming Soon)Home Delivery (Fees may apply)

Name*

First NameLast Name

Email

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What are you looking for today?*

Date being requested for*

Date

Length of time being requested*

All Rentals (Excluding GameReady Systems) have a minimum rental period of 4 weeks.

Length of time being requested*

All our rentals autorenew on a 4-week basis

Tell us a little bit about what you are looking for. Please be as detailed as possible*

File Upload

**IMPORTANT**

To better assist you for any Bedroom products, Bathroom aids, wheelchairs, rollators and patient lifts, we will require your approximate weight & height.

Weight

Height

ONLINE REQUEST FORM

Hospital Beds

Lifts & Transfer Equipment & Accessories

Bathroom Aid

Walkers

Wheelchair Rental

Wheelchair Accessories

Mobility Scooter Rental

Accessibilities