Equipment Reservation Request Form     [Back]

Disclaimer
Nasu Enterprises, LLC is not responsible for any medical condition, injury or damages resulting from the use of the equipment.
We encourage all lessees to consult with their physician/surgeon prior to using post-surgery positioning equipment.


Wherever you are, we can get the equipment to you by one of these methods: 

This equipment is small and portable enough to fit in any small car.
Please try to schedule at least 2 weeks in advance to avoid costly shipping charges and/or equipment shortages.

Rental prices: (1 Week Minimum Charge)

1) Face Support w/Armrest Shelf
-or-
2) Sleep System
$99/week
-or-
$99/week
3) Seated Support $119/week
4) Facedown Periscope Mirror $14/week
-Or-  
Vitrectomy Support Package
(1, 3, 4
or 2, 3, 4)
$199/week

Note: Rental of a 2nd sleep device, #1 or #2 will be discounted to $49/week.

 

Just fill out the following information below and a representative will be contacting you to finalize your reservation.

 

Name-example,  John M. Doe

 

Street Address

 

City State Zipcode

 

Phone #

 

E-mail Address Cell # (Optional)
Name of Surgeon (Optional)

 

Your Surgery Date Need Date
Male  Female
Your Height

 

Your Weight
Yes   No
Any Smokers in your Household?