KOOL Therapy | Rental Inquiry

Step 1 of 2

Request Your KOOL Therapy Rental

Takes less than 2 minutes.

Tell us a few details to get started.
We’ll review your request, confirm your delivery timing, and guide you through the rental agreement and secure payment.

Designed for comfort during recovery. Always follow your healthcare provider’s guidance when using KOOL Therapy.

Patient Contact & Shipping Information

Enter the patient’s contact information and the address where the KOOL Therapy unit should be delivered. Do not enter the provider’s office address unless KOOL Therapy has specifically instructed you to do so.

Patient First Name *

Patient Last Name *

Patient Email *

Patient Mobile Phone *

Patient Delivery Address *

Apartment, Suite, Unit, etc.

City *

State *

Patient Delivery ZIP Code *

Requested Delivery Date *

Procedure or Treatment Area *

Please select the date you would like to receive your KOOL Therapy unit. We recommend submitting your request at least 4 days in advance whenever possible. Earlier requests may be accommodated based on unit availability and delivery options, but requested dates cannot be guaranteed.

Procedure & Provider / Referral Information

This section identifies the surgeon or practice / facility connected with the procedure or referral.

This information is separate from the patient delivery address above and will not be used as the shipping destination.

Scheduled Procedure Date *

Surgeon / Provider Name

Practice / Facility Name

Additional Notes

Cancellation & Refund Policy: Cancellation terms vary depending on whether fulfillment has begun or the unit has shipped or been provided to the patient. You will review and accept the complete Cancellation & Refund Policy as part of the Rental Agreement before payment.

I understand rentals are for a standard 2-week term and I will review and sign the rental agreement before payment. *

I agree to be contacted regarding my rental request and next steps. *