1. Contact Details

First Name*
Last Name *Phone No *
Email *

2. Address Details

Hospital/Carehome Name *
Town *
Postcode *
Ward Number *
Address 2 (optional)
Address 3 (optional)

3. Rental

Bed System (£90.00 + VAT)

No Beds Required1 Bed System2 Bed Systems3 Bed Systems4 Bed Systems5 Bed Systems6 Bed Systems7 Bed Systems8 Bed Systems9 Bed Systems10 Bed Systems

Chair System (£80.00 + VAT)

No Chair System Required1 Chair System2 Chair Systems3 Chair Systems4 Chair Systems5 Chair Systems6 Chair Systems7 Chair Systems8 Chair Systems9 Chair Systems10 Chair Systems

Dual System (£110.00 + VAT) - this is made up of the bed panel, chair panel and control unit.

No Dual System Required1 Dual System2 Dual Systems3 Dual Systems4 Dual Systems5 Dual Systems6 Dual Systems7 Dual Systems8 Dual Systems9 Dual Systems10 Dual Systems

Paging System (£110.00 + VAT)

No Paging System Required1 Paging System2 Paging Systems3 Paging Systems4 Paging Systems5 Paging Systems6 Paging Systems7 Paging Systems8 Paging Systems9 Paging Systems10 Paging Systems

If you currently use a SensorCare paging system and would like your rental to work with your existing equipment, please provide the serial number or paging address of your base station.