Client's Details for Product Demonstration

Client Name

Client Email or Best Contact Email *

Client Phone *

Client Address *

Preferred Trial Location *

HospEquip Showroom
Clients Home

Client Location *

NDIS Funded? *

Yes No

Client DOB *

Client Height *

Client Weight *

Preferred Booking Date & Time | Monday - Friday during business hours only. *

Please note our team member will get back to you with alternative dates & times if your request is not available.

Products to be Demonstrated

Not all products are available for product trials or demonstrations. Product availability may vary state to state.

Select products *

If you can't find a product on our website, please advise what sort of product you are looking to trial in the message below. Certain low value or hygiene products are not available for demonstration.

OT or Plan Managers Details | Required for NDIS Clients

OT or Plan Manager Name *

Company *

Phone *

Email *

Additional Information

Message *

Name of Person Submitting Form *

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Cura1 Fall Monitoring