Demonstration Request

Simply complete our form below and we’ll be in touch

What type of equipment do you need?

Pressure Care	mattressseat cushionsback cushions
Wheelchairs	attendant propelledself propelledTISTIRscripted
Care chair	please specify
Bathroom Products	please specify
Others	please specify

Tell us about yourself

Tell us about your client/patient

Salutation
First Name
Last Name
Company
Position
Email
Phone
Address

Salutation
First Name
Last Name
Email
Phone
Address

I require a formal quote for:		Will you be applying for funding?
purchasehire		yesno
Will a therapist be onsite to assist with demo?		Which days does the therapist work?
yesno		montueswedthurfri
Preferred delivery day/time		Preferred pick up day/time

Is there anything else you need to tell us?

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The enabling power
of applied knowledge

Call: 08 9351 7500

Demonstration Request

Simply complete our form below and we’ll be in touch

What type of equipment do you need?

Tell us about yourself

Tell us about your client/patient

I require a formal quote for:

Will you be applying for funding?

Will a therapist be onsite to assist with demo?

Which days does the therapist work?

Preferred delivery day/time

Preferred pick up day/time

Is there anything else you need to tell us?

The enabling powerof applied knowledge

The enabling power
of applied knowledge