Rental Request Fill out the form below to request one of our rentals. We will contact you to complete the reservation. Name *Phone *Email *Address *Zip Code *Rental Type *Rental TypeElectric ScooterHospital Bed16″-18″ Wheelchair20″ WheelchairTransport ChairElevated Leg RestHoyer Patient LiftKnee WalkerReservation Start Date *Reservation End Date *Pickup & Delivery Options *Store PickupDeliveryPhoneSubmit