Medical Device Loaner Agreement

Date:

Parties

Lender:

Address:

Borrower:

Address:

Device Information

Device Name
Model
Serial Number
Accessories
Condition

Loan Terms

1. Loan Period:
2. Purpose of Loan:
3. The Borrower agrees to use the device only for its intended medical purpose and to comply with all applicable laws and regulations.
4. The Borrower shall not modify, transfer, or dispose of the device without written consent from the Lender.
5. The device shall be returned in the same condition as provided, reasonable wear and tear excepted.
6. The Borrower is responsible for any loss or damage to the device during the loan period.
7. The Lender may request the return of the device at any time with reasonable notice.
8. Upon conclusion of the loan period, the Borrower shall return the device to the Lender at the Borrower’s expense unless otherwise agreed.

Signatures