Bons Secour Hospital Tralee Cancel Equipment Order Form

Name of Person Cancelling Equipment*

Ward*
—Please choose an option—Day WardHigh Dependency UnitSt Brendan’s WardSt Bridget’s WardSt Joseph’s WardSt Patrick’s WardSt Theresa’s Ward

Product
—Please choose an option—Procare Auto Mattress

Product Rental No.*

(e.g. OFM1234) located on the pump/foot of the bed

Return Email*

Comment:

*indicates required field