Oxygen Rental Agreement Form

Oxygen Rental Agreement Form

"*" indicates required fields

CVH Oxygen Equipment Pricing

Medium Oxygen Tent w/5L Concentrator

$299 for Delivery/Setup/Training/& 1st Month

$99 for each additional month

$500 Deposit (to be returned to client when equipment is returned in good condition)

Large Oxygen Tent w/10L Concentrator

$399 for Delivery/Setup/Training/& 1st Month

$149 for each additional month

$750 Deposit (to be returned to client when equipment is returned in good condition)

Rule Requirements for Oxygen Equipment Rental

No smoking inside the home or near the equipment

No wet food inside of the tents

No liquids other than water inside of tents

Keep animal and tent as clean as possible

Do not leave your pet unattended for any amount of time while they are in the oxygent tent

Plug directly into wall outlet or surge protector; do not use extension cord.

Do not pile items on top of or near machine, as oxygen has to be able to flow freely and the machine may overheat.

I have read and understand the pricing and rule requirements for renting Compassionate Veterinary Hospice's Oxygen Equipment. I understand that I am responsible for the basic equipment upkeep and safety (keeping it clean, well-maintained, and in working order). I understand that if the equipment is returned to Compassionate Veterinary Hospice damaged, destroyed, or in need of maintenance (deep cleaning, factory cleaning or maintenance, etc.) I will lose my deposit and will not be able to rent any of this equipment in the future. I also understand my pet's health and safety are my responsibility at all times, including when using this equipment and will not hold Compassionate Veterinary Hospice responsible for any injury or harm my pet experiences during use of this equipment.*
Date*
For copy of this form for your records.
Printed Name*
Reset signature Signature locked. Reset to sign again
This field is for validation purposes and should be left unchanged.