Pressure Care Products Rental Request

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Patient Name: *

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King Single Mattress Replacement - (High Care) W/low>20

Peak Care Single MC-8-PK Mattress Replacement - (High Care) W/low >20

Peak Care Single MC-5-PK Mattress Overlay - (Medium Care) W/low 15-20

Peak Care Single MC-3-PK Mattress Overlay - (Low Care) W/low

Mattress Extension Hose (Req. for Floor Level Beds)

Roho/Equagel Cushion

Mattress/Cushion Number (Office Use Only)

Rental Agreement Number (Office use Only)

To cancel a Request filled out via the online form please click here to use our online cancellation form. Any enquiries Phone 5222 6664.
Whitecross Healthcare will Deliver & Collect rentals on a daily basis Monday to Friday & Saturday between 9.00am & 1.00pm.
Urgent after hours requests will be dealt with via after-hours co-ordinator with access to a Whitecross mobile phone.
Upon completion of the rental, Whitecross is to be faxed or emailed direct with the original Rental Agreement paperwork.
Whitecross will then collect the mattress/cushion on the next daily visit.
The mattress request form is to stay on the ward for invoice reconciliation at end of the month by Unit Nurse Manager.

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