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 team
3. Follow and complete the service with us

Delivery Fee depends on Address Area.

Full Name

Phone

I.C. No.

Email

Rehab Item to Rent:

Lightweight Wheelchair

Oxygen Concentrator 5L

Oxygen Concentrator 10L

2 Crank Manual Hospital Bed

Delivery Address

Remark:

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

Thanks for submitting!

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