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Rehab & Support Rental Form

This form allows you to request rehab rental with Sevens Care Pharmacy.

How Does It Work?
1. Complete the details
2. You will be contacted by our rehab team
3. Follow and complete the service with us

Delivery Fee depends on address given.

Full Name

Phone

I.C. No.

Email

Pick Your Rental Item

2 Crank Manual Hospital Bed

≤ 10 Days

1 Month

≥ 2 Months

Mattress *

Coconut Husk Mattress

High Density Full Foam Mattress

3 Crank Manual Hospital Bed

≤ 10 Days

1 Month

≥ 2 Months

Mattress *

Coconut Husk Mattress

High Density Full Foam Mattress

5L Oxygen Concentrator *

≤ 10 Days

1 Month

≥ 2 Months

10L Oxygen Concentrator *

≤ 10 Days

1 Month

≥ 2 Months

Delivery Address

Remark:

I declare that the info I’ve provided is accurate & complete

I have read and agreed to the Terms & Conditions

Thanks for submitting!

Our rehab team will contact you soon

Rental Service (3).png

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