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Online Reservation
Please fill out the form below. You will be contacted within 24 hours by one of our Patient Service Representatives to confirm your order.

First Name

Last Name

Contact Name

E-mail

Home Phone           Alternate Phone

Delivery Address

City    State     Zip

Date of Birth

Date of Surgery

Surgeon

Expected Length of Rental 


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2821 Wilbur Street, Battle Creek, MI 49037  |  Fax 269.968.8561  |  Phone Hours: 8am to 8pm EST Mon–Fri
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