Holter Rental Request Form

Please complete the following form to submit a request to rent one of the Gracie Initiative Holter Monitors. The cost to rent will be $100 to SSDCA members and $110 to non-members. This charge will include the expense for shipping the monitor (to and from), shipping insurance, required supplies and an evaluation of the holter results.

    Renter Information

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question