Rent Medical Equipment

Rental equipment can be rented and reserved by the week or month, depending on the item. We require three days advance notice to ensure availability of your equipment or delivery for larger equipment if needed.
If you require equipment within the next three days, please call us at 406-587-0608.

Your Information

First Name*
Last Name*
Date of Birth (MM/DD/YYYY)*
Contact Phone Number*
Home Address*
Address Line 2
Zip Code*
Insurance Card
Upload an image of your insurance card or bring it to your appointment.
Medical Equipment To Reserve (Choose up to 4)*
Medical Equipment To Reserve (Choose up to 4)*
There is a four day lead time for all rental requests.
Start Date (MM/DD/YYYY)*
End Date (MM/DD/YYYY)*

Rental Agreement/ Privacy Practices Acknowledged

Signature (type your full name)*