Get Horizon Medical Equipment

Filling out the Horizon Medical Equipment rental intake form is a straightforward process that enables you to request necessary medical equipment efficiently. This guide provides a detailed overview of the steps involved in completing the form accurately online.

Follow the steps to successfully fill out the rental intake form.

1. Click ‘Get Form’ button to access the rental intake form and open it for editing.
2. In the 'Equipment Needed' section, select the items you wish to rent from the options provided, such as walker or wheelchair.
3. Indicate the number of units needed by filling in the blank provided.
4. Specify the preferred delivery date and time in the designated fields.
5. If requesting a power wheelchair, indicate the expected length of need by selecting the appropriate time frame: 1 week, 2 weeks, or 1 month.
6. Enter the pickup date and time if applicable.
7. Provide your name or the name of your group in the 'Customer Name/Group Name' section.
8. Fill out the contact person’s name and provide both primary and alternative phone numbers.
9. Complete the delivery address or hotel information where the equipment is to be delivered.
10. List the height and weight of each person who will be using the requested equipment in the space available.
11. In the 'Billing Info' section, select the credit card type and enter the card number, expiration date, CVC, and billing zip code.
12. Read and acknowledge the rental terms and conditions by signing the signature line with your name and date of birth if submitting electronically.
13. Once completed, save your changes. You can then choose to download, print, or share the form securely via fax or email.

Start filling out your form online today to ensure you receive the medical equipment you need.