Elle TENS Rental Request

TENS (Transcutaneous Electrical Nerve Stimulation) works by passing mild electrical impulses through the skin, via electrode pads, into the nerve fibreswhich lie below. The TENS impulses help your body produce its own pain killing chemicals, such as ‘endorphins’. The level of pain relief obtained varies from person to person. Some find that the Elle TENS provides all the pain relief required during the whole of labour,whereas others find that other analgesics are also needed during the later stages of labour.

1. The TENS machine supplied will be used only by the person ("Renter") whose name appears on this form and is not transferable between individuals.

2. The Renter MUST receive approval from their medical practitioner before use of the TENS machine.
3. The success of TENS is in no way guaranteed.
4. TENS will be used following the instructions provided.
5. TENS cannot be used:

  • On open wounds that would interfere with the placement of  pads;
  • If Renter has history of epilepsy or seizures;
  • If Renter has a pace maker;
  • While laboring in water (but these are easily taken on and off before and after water use);
  • With an epidural or if Renter has an internal fetal monitor (external fetal monitoring is fine);
  • Before the 37th week of pregnancy (unless labor has begun).

6. If the TENS becomes lost, stolen or damaged, Crowning Glory Doula reserves the right to charge the full replacement value of $175.00.
7. Michelle Tyliakos and Crowning Glory Doula shall not be held responsible or liable for any injury or damage sustained as a result of using the TENS unit.
8. The rental period is for 1 calendar month. If the TENS unit is not returned for any reason, the full replacement value ($175) will be charged.
9. If your rental period expires before you have given birth, an extension to the 4 week rental period can be accommodated at no extra cost, but must be agreed upon prior to the expiry date.
10. In the event of a cancellation, the deposit of $15 is non-refundable. No refund will be provided after the TENS unit has been dispatched to Renter or for non-use of a machine.
11. TENS unit electrodes should be placed on the back, during  your birthing time, according to the instructions. Electrodes should not be placed on broken or inflamed skin.
12. Additional electrodes are $12 per set of four.
13. TENS units are to be kept away from water at all times. If you wish to have a bath, shower or enter your birthing pool, you must first turn off the TENS unit and remove the electrodes from your skin.
14. All pieces of the original package MUST be returned - this includes expired batteries.

By filling out the Rental Request Form, I (The UNDERSIGNED), am 19 years or older, acknowledge that I have read the contract and understand and agree to the terms outlined above.   

Name *
Name
Address *
Address
Phone *
Phone
Estimated Due Date *
Estimated Due Date
Date you would prefer to pick up *
Date you would prefer to pick up
Rental is for 1 full calendar month
Checkbox *
Choose Rental Preference
Payment Method *