Elle TENS Rental Agreement 

​Thank you for choosing to rent an Elle TENS unit from Sage Roots Doula Services!  Please contact me to confirm availability of the Elle TENS unit prior to completing this agreement. Once you've submitted the rental agreement you will receive a confirmation email and an invoice for the $50 security deposit, to complete your reservation.  Arrangements will then be made for pickup or delivery of your rental unit, final payment, and reimbursement of your security deposit upon return of the unit.  A receipt can be provided for those wanting to submit a receipt to extended health benefits for reimbursement.

The following rental agreement will take place between Sarah Wauthy of Sage Roots Doula Services (the “owner”) and the individual named below (the “renter”).

    Birthing Person's Information (the "renter")
    ​Terms and Conditions
    1. The Elle TENS machine supplied will be used only by the person (“renter”) whose name appears on this form and is non transferable.
    2. The Elle TENS machine will be used according to the instructions included along with the rental unit.
    3. The Renter MUST receive approval from their medical practitioner before use of the TENS machine.
    4. The success of TENS is in no way guaranteed.
    5. The Elle TENS unit will be tested before dispatch and will be supplied in good working order, ready for use and will be returned in the same condition received.
    6. This rental includes: 1 Elle TENS unit, 1 package of electrodes (a set of 4), 2 sets of AA batteries (4 in total), 2 lead wires (plus one spare), 1 neck cord, Instruction Manual, Quick Start Guide, A Woman’s Guide to Drug Free Pain Relief (booklet), and a carrying pouch.
    7. In the event that the TENS unit becomes lost, stolen or damaged in any way, or becomes contaminated with bodily fluids, the renter will be charged the replacement value of $175.00.
    8. The rental period is for 35 days.  Unless otherwise agreed upon with the owner, it is expected that the rental unit will be returned by the last day of the rental period. To extend the length of the rental, the renter must contact the owner prior to the expiry date, and an additional $15 will be charged for each week or part thereof until the unit is returned. If the Elle TENS unit is not returned for any reason the full replacement charge of $175 will apply.
    9. TENS units are NOT compatible with water and should never come into contact with water or fluids of any kind. If you intend to use the shower, bath or birthing pool, you must first turn off the Elle TENS unit and remove the electrode pads.
    10. It is the renter's responsibility to familiarize oneself with the Elle TENS machine, the components, and to read through the instruction manual. In the event that the renter discovers any issue whatsoever, the owner must be notified immediately. Failing to do so makes it impossible for the owner to take corrective action and so the owner takes no responsibility if not notified immediately.
    11. Sage Roots Doula Services shall not be held responsible or liable for any injury or damage sustained as a result of using the TENS unit.
    12. All pieces of the original package MUST be returned, including expired or drained batteries, except for used electrodes. Used electrodes can be disposed of.
    13. Additional electrodes can be purchased for $15 for a set of 4.
    ​Rental Fees
     ​Security deposit:  A $50 deposit is due with this contract and will be refunded upon return of the Elle TENS unit.  This deposit will be applied toward any extensions on the length of rental or any additional amounts owed for damage or loss of the Elle TENS unit.

    Rental:  The Elle TENS unit is $70 for the rental period of 35 days and includes one set of four electrodes. Every additional week, or part there of, is an additional $15.

    Delivery and pickup service is available for an additional $15, within Greater Victoria, excluding Sooke.
    ​
    Payments can be made by cash, cheque or e-transfer to sarah@sageroots.ca.  Please make all cheques out to Sarah Wauthy.
    Cancellation & Refund Policy
    ​If the rental agreement is cancelled prior to the owner dispatching the rental unit, the renter will be refunded the rental fee less an administration fee of $15.

    No refund will be made after the unit has been sent to the renter, even if the unit is not used.
    Precautions & Contraindications
    • Do NOT use this unit without first reading all instructions provided with the TENS unit.
    • TENS machines contain electrical components and MUST NOT be used in or around any liquid (including water or fluids). Turn off and remove the TENS and electrodes before entering a bath, shower or birthing pool.
    • TENS should NOT be used by persons with a cardiac pacemaker, any heart disease, epilepsy or seizures.
    • TENS should NOT be applied internally or used on broken skin.
    • Keep the TENS unit and all components out of reach of children and pets.
    • NOT to be used by pregnant individuals before 37 weeks gestation without prior consultation and agreement from your care provider.
    I, the renter, acknowledge that I have read the above Elle TENS Rental Agreement from Sage Roots Doula Services and release the owner of any liability.  By entering my name below I, the renter, agree to the Terms and Conditions for the Elle TENS rental unit as outlined above. 

    Signature will be obtained upon receipt of the TENS machine.
​Sarah Wauthy CD(DONA)
​250-889-6882
​sarah@sageroots.ca

Victoria, BC Canada
Copyright © 2015, Sage Roots Doula Services. All rights reserved.