Citizens Pharmacy Medical Equipment Rental Agreement

Citizens Pharmacy Medical Equipment Rental Agreement
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My Products
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Wheelchair 2 Month Rental
Available 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
Available in black and pink. One handed braking systemIncludes wire basketWeighs 27 lbs.300 lbs. max capacity

$120.00



Rollator Walker Monthly Rental
$90.00 Quantity



Total

$0.00
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ADMINISTRATION

For Pharmacy Use Only
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ADMINISTRATION