TENS Rental Form

This rental agreement is entered into between the individual named in the TENS Rental Form ("Renter") and Knoxville Hospital Doula, LLC ("Owner"), for rental of a Transcutaneous Electrical Nerve Stimulation (TENS) unit. By renting a TENS unit, Renter acknowledges and agrees to the terms and conditions outlined in the TENS Rental Agreement and the associated TENS Usage Liability Waiver. // TENS RENTAL includes: 1 Babycare ELLE TENS 1 unit, 1 Lanyard, 2 sets of two AA batteries, 1 set of two lead wires, Instructions for use, Carrying Case, 1 set of four single-user Babycare TENS electrodes. The Rental Period term begins at the Requested Start Date indicated in the TENS Rental Form and concludes either six weeks (42 calendar days) or one week (seven calendar days) thereafter, depending on the reservation length purchased by Renter in the TENS Rental Form. By completing this Form, Renter is agreeing to rent the listed components from Owner AND is agreeing to return the TENS unit and all listed components except the electrodes in undamaged, working condition by the end of the Rental Period. Please do not return electrodes. A Security Deposit has been added to your rental order, and is refundable via electronic payment within two business days of receipt and inspection of your returned rental, only if all components other than electrodes are returned in undamaged, working condition by the expiration of the Rental Period. Returns must be received by Owner by the expiration of the Rental Period, whether returned in person or by prepaid shipping label purchased at time of rental agreement. The full deposit will be non-refundable without exception if your rental is returned late or is deemed to be in unsatisfactory condition at Owner's sole discretion. TENS Rental Agreement may be canceled at any time prior to the Requested Start Date; If canceled, Renter will be refunded the rental fee and Security Deposit less $30.00 USD for reservation of the unit; no refund of the rental fee will be made after the Requested Start Date or for non-use of the unit. TERMS OF USE. 1. The TENS unit will be used according to the instructions included along with the rental unit. 2. The TENS unit being rented is only meant to be used by the person whose name appears on this form and is non-transferable to other users or other rental dates. 3. The TENS unit will be tested before dispatch and will be supplied in good working order, ready for use and will be returned in the same condition received. 4. TENS rental includes: 1 Babycare TENS Elle 1 unit, 1 Lanyard, 2 sets of two AA batteries (one set within the unit and the other in a sealed package), 1 set of two lead wires, Instructions for use, Carrying Case, 1 set of four single-user Babycare TENS electrodes. 5. In the event that the TENS unit or any part thereof is lost, stolen or damaged in any way, or becomes contaminated with bodily fluids, the deposit will be non-refundable. 6. The rental period is for a maximum of either 6 weeks or 1 week from the Requested Start Date, as indicated on the TENS Rental Form. It is expected that the rental unit will be returned by 5:00pm EST on the last day of the rental period. If the TENS unit is returned late or not returned for any reason, the entire Security Deposit will be non-refundable. 7. TENS units are NOT compatible with water and should never come into contact with water or any fluids. If you intend to use the shower, bath or birthing pool, you must first turn off the TENS unit and remove the TENS pads. 8. It is the Renter's responsibility to familiarize oneself with the TENS unit, the components and to read through the instruction manual within 24 hours of the Requested Start Date. In the event that the renter discovers any issue whatsoever, Renter must notify Owner immediately via email. Failing to do so makes it impossible for the owner to take corrective action and so the owner takes no responsibility if not notified immediately. 9. All pieces of the original package MUST be returned, including expired or drained batteries, except for used electrodes. Used electrodes should be disposed of by Renter. By signing below, Renter attests that they: (i) DO NOT suffer from epilepsy, nor do they have a cardiac pacemaker or any known/unknown/suspected heart disease. (ii) Will NOT use the TENS unit or any components in or around water or bodily fluids. (iii) Have obtained counsel from their clinical provider and have clinician's specific agreement with regard to using a TENS unit on their body. (iv) Will NOT use the TENS unit whilst pregnant before 37 weeks gestation without prior consultation and specific agreement from their clinical provider. (v) Will NOT apply TENS electrodes internally or on broken or numb skin. (vi) Will NOT place electrodes over their heart, abdomen or chest. (vii) Will keep the TENS unit and electrode pads out of reach of children and pets. (viii) Agree to abide by the terms of the TENS Usage Liability waiver. (ix) WILL NOT hold Knoxville Hospital Doula, LLC responsible or liable for any injury or damage sustained as a result of using or misusing the TENS unit. 

Please read this disclosure carefully before using any Transcutaneous Electrical Nerve Stimulation (TENS) unit. By using a TENS unit, Renter acknowledges and agrees to the terms and conditions outlined in this disclosure. If Renter does not agree with these terms, Renter agrees not to use the TENS unit. NOT MEDICAL ADVICE. This TENS unit is intended for personal use as a non-medical pain management device during childbirth. The information provided with this unit, including any instructions, guides, or promotional materials, is for informational purposes only and does not constitute medical advice. It is not a substitute for professional medical diagnosis, treatment, or advice from a qualified healthcare provider. Always consult with a physician or other qualified healthcare provider before using this TENS unit, especially if you have any pre-existing medical conditions, have a pacemaker, are pregnant or planning to become pregnant, or have any other health concerns. USER RESPONSIBILITY. You are solely responsible for your use of this TENS unit and for any consequences that may arise from its use. It is your responsibility to: (i) Consult a Healthcare Professional: Seek professional medical advice before using this device. (ii) Read and Understand Instructions: Thoroughly read and understand all instructions, warnings, and contraindications provided with the TENS unit before operation. (iii) Follow Instructions: Use the TENS unit strictly in accordance with the provided instructions. Do not deviate from recommended settings, placement, or duration of use. (iv) Monitor Your Body: Pay close attention to your body’s response during and after TENS unit use. Discontinue use immediately if you experience any discomfort, pain, skin irritation, or adverse reactions, and consult a healthcare professional. (v) Proper Maintenance: Ensure the TENS unit is properly maintained and stored according to the manufacturer’s guidelines. POTENTIAL RISKS AND SIDE EFFECTS. While TENS units are generally considered safe when used as directed, there are potential risks and side effects, including but not limited to: (i) Skin irritation, redness, or burns at the electrode sites. (ii) Allergic reactions to electrode pads or gel. Muscle soreness or twitching. Interference with electronic medical devices (e.g., pacemakers, defibrillators). (iii) Aggravation of existing medical conditions. This list is not exhaustive. If you have any concerns about potential risks, consult your healthcare provider. CONSIDERATIONS Do not use this TENS unit if you: (i) Have a pacemaker, implanted defibrillator, or other implanted electronic devices. (ii) Have epilepsy or a history of seizures. (iii) Have heart disease or a history of cardiac issues. (iv) Have cancer, especially in the area of application. (v) Have skin lesions, open wounds, or areas of infection where electrodes would be placed. (vi) Are in or around water. (vii) On numb skin, including any area impacted by anesthesia or numbing medication. (viii) Prior to 37 weeks gestation. (ix) Without clinical provider counsel and agreement. This list is not exhaustive. Consult your healthcare provider for a complete list of contraindications relevant to your individual health. LIMITATION OF LIABILITY. Knoxville Hospital Doula, LLC and its affiliates, distributors, and retailers shall not be liable for any direct, indirect, incidental, special, consequential, or punitive damages, including but not limited to personal injury, property damage, or economic loss, arising from or in connection with the use or misuse of this TENS unit. This limitation of liability applies even if Knoxville Hospital Doula, LLC has been advised of the possibility of such damages. NO WARRANTY. This TENS unit is provided “as is” without any warranties, express or implied, including but not limited to implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Knoxville Hospital Doula, LLC does not warrant that the TENS unit will meet your specific requirements or that its operation will be uninterrupted or error-free. INDEMNIFICATION. By using this TENS unit, you agree to indemnify, defend, and hold harmless Knoxville Hospital Doula, LLC and its officers, directors, employees, agents, and affiliates from and against any and all claims, liabilities, damages, losses, costs, expenses, or fees (including reasonable attorneys’ fees) arising from your use or misuse of the TENS unit, your violation of this disclosure, or your violation of any rights of another. GOVERNING LAW. This disclosure shall be governed by and construed in accordance with the laws of Tennessee, United States of America, without regard to its conflict of law principles. SEVERABILITY. If any provision of this disclosure is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. ACKNOWLEDGEMENT. By using this TENS unit, Renter acknowledges that you have read, understood, and agree to be bound by the terms and conditions of this legal disclosure.