Toronto Medical Supply Inquiry Form

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

Latest Testimonial

Thank you for the exceptional customer service. We are very pleased with the hospital bed.

Jimmy Ge

April 1 2024

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Amazing customer service from the person taking order and providing information to the person helping to set up equipment. Highly recommend!

Barb Ginn

March 6 2024

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Great service in-store and also upon delivery. Very knowledgable and highly recommended.

Bessy Valerio

February 13 2024

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Claudia at the Vaughan location was a great help to me in selecting the right bed, mattress and lift chair for my mother. I went with the Medline Med Lite bed and the Pride VivaLif...

DK.

February 10 2024

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I needed a bed for my mom delivered right away to her retirement home. The whole process went very smoothly! Very happy with the service.

Marc Russell

February 6 2024

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