Mayfield Medical Services - Physical Therapist Service Contract Quote Request

Request A Service Quote

Physical Therapist Equipment Service Request

Name:
Organization:
Phone:
Email:
Address:
City:
Zip:
Please specify the number of each type of equipment in use at your facility. Additional space is provided at the bottom for any additional types of equipment not already listed. A printable version if this form is available by clicking here.

Blood Pressure Units		Carpal Tunnel Machines
Carts		Compression Therapy Machines
CPM Devices		Defibrillators & AEDs
Elecrotherapy Machines		Exercise Bikes
Gel Warmers		Hydrocollators
Imaging Equipment		Laser Therapy Machines
Massagers		Monitors
Muscle Stimulators		Other Exercise Equipment
Paraffin Baths		Patient Lifts
Scales		Standing Products
Tables		Thermolators
Traction Tables		Treadmills
Ultrasonic Cleaners		Ultrasounds
Warmers		Whirlpools
X-Ray Illuminators