Contact Info

Full Name *

Phone *

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Billing Address

Street Address *

City

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Postal code

Shipping Address

If different than Billing address

Product

Select the Products you would like to rent

Avazzia Blue Kit with Y Bar [ $50 per week ]

Avazzia Medsport kit with Y Bar [ $65 per week ]

Avazzia RSI Kit with Y Bar [ $100 per week ]

Avazzia ProSport Ultra Kit [ $165 per week ]

Avazzia ProSport 3 Kit [ $225 per week ]

QRS Pillow & Mat [ $225 per week ]

Axiom H300 [ $400 per week ]

Accessories

Avazzia Qiwave Small [ $15 / week ]

Avazzia Qiwave Large [ $25 / week ]

Avazzia Full Body Charging System [ $20 / week ]

Rental Contract *

This Agreement is between Renter and Provider (First Alternatives LLC). The rented device(s) (hereinafter "Rental") must be prepaid at signing (no exceptions). Additional rental periods must be paid in advance. If Renter elects to purchase the Rental, Provider may apply a percentage of rental fees toward the purchase price, at Provider's discretion. Provider will collect credit card details to cover any damage or loss during Renter's possession. Renter authorizes such charges. Provider will inspect the Rental upon return. Renter must purchase electrode pads separately. Renter must provide valid ID, phone number(s), and usage address. Both parties must sign this Agreement. A shipping fee (based on address) plus $20 setup fee applies to the first week. Shipping defaults to FedEx Ground; contact 954-789-2097 for expedited options at extra cost. Usage Guidelines Adhere to these rules: Do not drop the device (voids warranty). Do not use near water (e.g., bathtub, toilet, sink). Pull electrode lead wires only at the pin. Do not pull electrode pads by the wires (damages electrodes/wires). Do not allow play with the device; it is not a toy. Avoid holding the device with fingers on onboard electrodes (risk of shock and drop). Ensure understanding of device operation: power button, +/- intensity buttons, mode selectors, indicator lights, lead wire/accessory port, and 1-hour timeout prevention. If a prescription is required, Renter must submit it via fax, email, or DocuSign to Provider. This Agreement is governed by Florida law. If any provision is invalid, the remainder remains enforceable. It constitutes the entire agreement, superseding prior ones. Amendments must be written, signed by both, and attached.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

A First Alternatives Representative will reach out to you for payment over the phone or a link will be emailed to you to complete rental purchase. Shipping is processed M-F, please allow at least 3 Business days anywhere in USA. Call office 954-789-2097 for expedited shipping requirements.

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FA Rental

First Alternatives

First Alternatives

Hours 9 am - 5 pm EST

[email protected]

Fax : 772-872-6620

For Rep inquiries [email protected]

Prescriptions to [email protected]