Call: 08 9351 7500

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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