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

Excellent service; friendly and knowledgeble; bought a reclining chair and walker

Nanda Gamage

September 18 2024

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We have had nothing but good experiences at Vital Mobility. Staff are extremely kind and considerate.

Sylvia McLelland

September 17 2024

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Vital Mobility staff especially Bruno at the Vaughan location were very cordial and helpful in assessing the air mattress and pump I brought in. Tried some troubleshooting scenario...

Arie Vanderlely

September 11 2024

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Excellent service from Lydia from from product description, quick purchase and delivery.

Debra Luneau

September 9 2024

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When the time was limited and I needed to find equipment, the team at Vital Mobility was there to help me find the right fit for our needs! They were easy to talk to and knowledgea...

Carolyn Mastrotucci

September 5 2024

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