100 Bass Pro Mills, Unit 44 Concord, ON, L4K 5X1

Phone: (647) 430 7176

Mon-Fri 9:00-17:00

Toll Free: 1-866-50 VITAL (1-866-50 84825)

Sat 10:00-14:00. Sunday Closed

For home delivery service of all types of mobility equipment, please complete the form below. Once we receive your rental request, a Vital Mobility operator will respond with a detailed quote via e-mail.

Personal Information

First Name *
Last Name *
Address Line 1 *
Address Line 2
City *
Province *
ZIP / Postal *
Equipment User's Height *
Equipment User's Weight *

Preferred Contact Method

Contact me by:

Telephone

E-mail

Please provide both your telephone and e-mail address in case we cannot reach you by your preferred contact method:

Area Code + Phone *
Area Code + Work Phone
Email Address

Rental Information

Equipment Type:

Scooter	Wheelchair	Rollator	Walker	Crutches

Equipment types shown here are examples only and may vary based on your location.

Destination Address Line 1 *
Destination Address Line 2
Destination City *
Destination Province*
Destination ZIP / Postal *
Date Needed From *
Date Needed To *

Will someone be at the door and available to receive the rental equipment when our driver arrives? (please enter Yes or No). If No, please enter the details in the Special Needs section below.

Special Needs or Concerns

100 Bass Pro Mills, Unit 44 Concord, ON, L4K 5X1

Products

Personal Information

Preferred Contact Method

Rental Information

100 Bass Pro Mills, Unit 44 Concord, ON, L4K 5X1

Sales • Rentals • Services