Name *

First Name

Last Name

Phone

(###)

###

####

I would like to rent: *

Birth Pool

TENS Machine

Peanut Ball

Birth Ball

I want to bundle multiple rentals!

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am interested in: *

Delivery and pick up is included in the rental cost for those living in Guelph, Elora and Fergus. All other locations are subject to an additional $50 (total) delivery and pick up fee.

Having my rental delivered and picked up by you.

Picking up and returning my rental to your clinic in Guelph.