Trial our devices for free

You can still submit this trial form

However, your local consultant will not be able to progress the trial until Access training is complete

Parent/guardian or other nominee information:

Speech Pathologist’s information:

If you are not the above mentioned Speech Pathologist or parent/guardian please list your details.

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60 and 84 location

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60 and 84 location

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60, 84 and 144 location

Note, this device comes with the 84 location keyguard as standard

You will receive a table stand with this trial device

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60 and 84 location.

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60 and 84 location.

Note, this device comes with the following keyguard and touchguide options as standard: 45, 60, 84 and 144 location

Note, this device comes with the 84 location keyguard as standard.

You will receive a table stand with this trial device.

All Liberator equipment trials are free of charge, including freight.

Please read the following conditions & indicate your agreement below:

• No equipment will be issued until a Trial Agreement Form has been received.
• No equipment will be issued until the primary therapist completes Access training and/or is exempt from completing this training. Speak to your local consultant if you are unsure.
• Items can be trialled for between 1 and 3 weeks.
• If longer is then required than that stated on the form, Liberator must be notified and agree to any such extension.
• If a device is returned later than the agreed date, then a $50 late fee will be charged for every week or part thereof beyond the due date.
• If a device is returned in an unclean condition, then Liberator may apply at its discretion a cleaning fee of $50.
• All equipment is to be returned in the packaging sent by Liberator. Every item and accessory sent by Liberator must be returned; otherwise, the customer will be charged for replacements. Each consignment will include a checklist signed by Liberator’s dispatcher. If there is any discrepancy, please notify Liberator immediately.
• Equipment is to be returned via Liberator's e-parcel service, so as to enable tracking and proof of delivery.
• Liberator will absorb any damage costs, including physical damage sustained to trial devices. We know that the likely incidence of significant damage is slight, but in any event Liberator will not seek restitution, but will simply repair the equipment and return it to you for the duration of the Agreement. However, Liberator expects due care to be taken wherever possible by all concerned. Loss or total destruction of the devices through negligence remains a liability. Yet, Liberator would only ever seek to recoup the replacement value from families/organisations in such circumstances, which is substantially less than the retail price.

If trialling a floor mount:

• We recommend that an OT is involved in the setup of the mount and trial process.
• Before setting up the floor mount, the SP (and OT if involved) must read the User Guide and Safety Instructions, and watch the "Assembling the FS TeleLock QP" and "Adjusting the FS TeleLock" tutorials on the Rehadapt FS TeleLock QP webpage.
• We recommend contacting your Liberator state consultant to request in-person support for setting up the mount.

In submitting this application, you are agreeing to the prompt return of the device
on or before the due date.