Therapist Trial Request 2v2

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Friday, January 24, 2025
SuperPharmacyPlus Trial Request Form

Thank you for choosing SuperPharmacyPlus Mobility for dry trialling of equipment. We love to work with therapists of all disciplines, and want to make the process as seamless as possible for you. This equipment is provided free of charge to therapists who have registered with us.

To allow us to assist you further, please complete the following form, or alternatively speak to our staff on (07) 3355 3052.
Trial loans are for the greater Brisbane area only.

Length of Trial
Unless otherwise approved, please aim to return loan equipment within 1 week.

Successful Trial:
Please feel free to leave the equipment insitu for the benefit of your client should the trial be successful. We will bill your nominated funding provider directly with the details provided in the form below.

Organization
Co.As.It
Name
Diana Barreto
Client Name
Beatrice Ryan
Delivery required?
Pickup From SuperPharmacyPlus
Funding Type:
STRC
Items / Other Comments
1x ASpire Vogue Indoor Walker CHampagne 1x Trustcare Indoor Walker Beech Collected instore already. JS.
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