WE RENT OXYGEN CONCENTRATORS IN FORT WORTH TX

$ 375.00

7 Day Rental

PRESCRIPTION REQUIRED DEPOSIT REQUIRED

Probable Inogen Oxygen Concentrator

$ 200.00

7 Day Rental

PRESCRIPTION REQUIRED DEPOSIT REQUIRED

Inhome Oxygen Concentrator

Rent The

Inogen g5

Located in Fort Worth TX

An ideal solution for patients looking for a POC that maximizes their range for oxygen delivery in a system that is quiet, easy to use, and easy to maintain. The Inogen® g5™ provides an adaptable design as a lightweight device that has multiple product configurations for life on the go. Patients can feel peace of mind to take time to roam – like spending quality time with family and friends, enjoying the great outdoors, and traveling.

Oxygen Flow

Pulse dose delivery system Six flow settings: 1-6

Noise Level

38 dBA*

Weight

2,2 kg. (4.7 lbs.) (includes single battery) 2,6 kg. (5.7 lbs.) (with extended-life battery)

Power

Single Battery up to 6.5 hours Double Battery up to 13 hours

Size

Length: 18,26 cm. (7.19 in.) Width: 8,28 cm. (3.26 in.) Height: 20,7 cm. (8.15 in.) (includes single battery)

Power

AC Power Supply 100-240V, 50-60Hz (auto sensing to allow worldwide use). DC Power Cable: for mobile use.

Operation

Simple control functions and easy-to-read LCD display.

Inogen

For Rental

Probable Inogen Oxygen Concentrator

Do I need a prescription to rent a POC?

Yes! We Require A Prescription From Your Physician Before We Will Release A Portable To You.

DFW Massage Chair Rentals

POC Confirmation Of Education

Please read and initial each statement below to verify that you understand the use and care of the equipment you are receiving today.

By signing this, the Customer assumes all responsibility for the proper use and care of the portable oxygen concentrator and all its components.


Travel Outside Of Service Area

DFW Massage Chair Rentals (DFWMCR)

1-817-773-7666

I acknowledge full understanding that DFWMCR currently does not have any other locations to service my oxygen needs near my travel destination.
I acknowledge full understanding that DFWMCR will not be able to service my oxygen unit or needs if it were to malfunction in any way.
I acknowledge full understanding that if I need any type of oxygen assistance due to malfunction or breaking of the unit, I will need to Contact Oxygen-To-Go or an oxygen company location in the city of my travel destination.
I acknowledge full understanding that Oxygen-To-Go or any other oxygen company is a separate oxygen provider from DFWMCR, and they may charge me privately for all services rendered.

***Traveling with oxygen is not considered medically necessary and is typically not a covered benefit under your health insurance.***

I acknowledge full understanding that it is my responsibility to keep a copy of my oxygen prescription with me if any other oxygen services are required in the city of my travel destination.

Oxygen-To-Go: Phone 1-877-736-8691 Fax 1-866-903-9709

By signing below, I agree to and acknowledge full understanding of the conditions listed and initialed above.

DFW Massage Chair Rentals (DFWMCR)

Portable Oxygen Concentrator Rental Agreement

Section 1: Rental Pricing

DFWMCR will provide (1) Portable Oxygen Concentrator (POC) package to each customer who desires to rent the package. Each rental period must be a minimum of (1) week. Rental weeks are in increments of (7) days, and a daily rate will be charged for any rental days outside of the normal (7) day increments.

The following equipment has been or will be provided to the customer as part of this agreement:

Section 2: Agreement To Rent

DFWMCR agrees to rent to the Customer (“Customer” is defined as both the payer and the user of the equipment, if not the same), and Customer agrees to rent from DFWMCR, the Portable Oxygen Concentrator (POC) Package, hereafter designated equipment, described above, and except otherwise provided herein, will continue until the end of the effective dates of rental. The Customer agrees to use the equipment as directed by DFWMCR and as prescribed by their physician.

NOTE: The rental period begins when the Customer receives the device, either in home or when picked up from DFWMCR. The rental period ends when the devise has been returned to DFWMCR.

Cancellation Of A Reservation:

DFWMCR agrees to rent to the Customer (“Customer” is defined as both the payer and the user of the equipment, if not the same), and Customer agrees to rent from DFWMCR, the Portable Oxygen Concentrator (POC) Package, hereafter designated equipment, described above, and except otherwise provided herein, will continue until the end of the effective dates of rental. The Customer agrees to use the equipment as directed by DFWMCR and as prescribed by their physician.

Section 3: Payments And Additional Billing Circumstances

Rental Charges

The Customer agrees to provide payment for all applicable charges prior to or at the time of delivery/pick-up. DFWMCR will NOT bill the Customer’s insurance for the cost of the rental under any circumstances.

Additional Billing

DFWMCR will charge the Customer’s credit card for any additional rental days/late fees at the time that DFWMCR is once again in possession of the equipment, minus the refundable deposit which will be processed once the unit has been inspected for any incurred damages.

Failure To Return The Equipment

If the equipment is not returned within ten (10) business days of the eƯective rental dates, as shown on this agreement, a purchase price of $2,950.00 (+) $620.00 per additional battery not returned, will be applied to the “Customer’s” credit card.

Damaged Equipment

If said equipment is damaged and needs repair, DFWMCR will notify the “Customer” of the need for repair after an inspection is completed, and the cost of said repairs will be charged to the “Customer’s” credit card. Please see below for the breakdown of replacement charges. If said equipment is lost/damaged beyond repair, the full purchase price of $2,950.00 (+) $620.00 per additional battery will be charged to the “Customer’s” credit card.

NOTE: For your safety, DO NOT SMOKE while you are using this equipment. Smoking or allowing others to smoke or having open flames near the equipment is PROHIBITED. If said equipment is returned with damage caused from smoke or open flame, the “Customer” will be responsible for the full replacement cost of the equipment and all accompanying accessories as detailed above.

Section 4: Customer Responsibility

Air Travel

The POC and accompanying equipment are all FAA approved: however, each airline has different regulations and requirements for using in-flight oxygen. If you are using the POC for a flight, you will need to contact the airline you are traveling with, prior to your departure date, to discuss any documentation and battery requirements needed to bring and use the equipment on your flight. It is the Customer’s responsibility to ensure that all the proper documentation has been obtained prior to the Customer’s travel dates as well as ordering the quantity of batteries required for the entire travel time from departure airport to arrival airport.

Notifying Your Physician

Not all patients are able to use a POC, so it is important that you discuss your travel plans with your physician prior to your departure date. In addition, though the Inogen is approved for nocturnal use, if you want to make arrangements for a stationary concentrator for nocturnal use in your destination city, it will be the Customer’s responsibility to coordinate the additional equipment.

Shipping

If the Customer has rented a POC, but is unable to return the unit as scheduled, the Customer may ship the unit back to DFWMCR. The Customer will be responsible for all shipping costs and arrangements to get the equipment back to DFWMCR. If the equipment is lost or damaged during the shipping process, the “Customer” will be responsible for all repair/replacement costs as detailed in Section 3.

Rental Summary

Rental Item Quantity Number of Rental Weeks Unit Price Unit Total
Inogen POC 1 $375.00
A/C Power Supply 1 N/A N/A
D/C Adapter 1 N/A N/A
16-Cell Battery 1 N/A N/A
Carrying Case 1 N/A N/A
Additional Batteries 1 $25.00/EA
Refundable Rental Deposit 1 $1,200.00 $1,200.00
Total Amount Due $1,200.00
NOTE: To avoid late cancellation fees, please cancel your reservation no later than:
NOTE: By signing this agreement, the “Customer” agrees to the terms set forth in the agreement. “Customer” also agrees to allow DFWMCR to directly charge “Customer’s” above listed credit card for any and all charges related to this agreement.

DFW Massage Chair Rentals (DFWMCR)

Portable Oxygen Concentrator Rental Agreement

1. Fill out the form 

2. Download pdf with your changes

3. Save it 

4. Upload the PDF file Agreement here

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