Please fill out the form below to borrow equipment, we will get back to you as soon as we can to take the next step.
* = Required.
Parent or Legal Guardian Contact Information
important Note: Your Therapist PT/OT/Speech MUST help with fitting and instructing you in the use of this equipment. COLE does not help with instruction or fitting of equipment.
Did you try to get this equipment through insurance or other funding source?
What is your insurance type?
How did you hear about us?